PRIVATE  LIBRARY 

of 
KIMBALL  YOUNG 


SEXUAL  IMPOTENCE 


THE  PATHOLOGY 
AND  TREATMENT 


OF 


SEXUAL   IMPOTENCE 


BY 

VICTOR  G.  VECKI,  M.D. 


FROM   THE   AUTHOR'S  SECOND  GERMAN 
EDITION,    REVISED   AND    REWRITTEN 


PHILADELPHIA 

W.   B.  SAUNDERS 

925  WALNUT  STREET 
1899 


Copyright,  18H9,  by  W.  B.  SAUNDKRS. 


.-_  _____ 

umvaicsiTY  OP  PA*  pro' 

JUNTA  BARBARA 


PREFACE. 


WHEN  the  first  German  edition  of  this  work  was  pub- 
lished, in  1889,  there  was  some  commotion  in  the  ranks 
of  old  and  young  medical  fogies,  who  were  indignant 
that  any  one  dared  to  resist  their  intellectual-  tendencies, 
refused  to  worship  their  superannuated  gods. 

The  second  German  edition  found  the  ranks  of  the 
same  kind  of  professional  formula-riders  and  bigots 
solid,  though  somewhat  thinned. 

I  have  taken  the  liberty  of  preserving  the  indepen- 
dence of  my  altruistic  opinions,  and  shall  continue  to 
fight  against  false  and  hypocritical  quasi-scientific  pre- 
tensions.  The  circumstance  that  my  work  has  been 
given  earnest  consideration  by  authorities  like  Casper, 
Eulenburg,  Fiirbringer,  Krafft-Ebing,  and  others  makes 
it  easy  to  bear  all  the  acrimonious  aggressions  dictated 
by  the  bilious  nature  of  some  of  the  "  Dii  minorum 
gentium." 

I  wish  to  thank  Professor  A.  A.  D'Ancona,  who  kindly 
revised  the  manuscript  and  helped  me  in  many  other 

ways. 

THE  AUTHOR. 
22  GEARY  STREET, 

SAN  FRANCISCO,  GAL. 


PREFACE 

TO    THE    SECOND    GERMAN    EDITION. 


Ix  UK/  lapse  of  seven  years  passed  since  the  publica- 
tion of  the  first  edition  of  this  work,  we  can  record  but 
very  little  progress  in  the  theoretic  as  well  as  the  practi- 
cal development  of  our  subject.  We  know  to-day  just 
as  much — or,  better,  just  as  little — about  the  physiology 
of  the  sexual  act  as  we  did  seven  years  ago. 

Quite  new,  indeed,  is  an  abundance  of  newly-forged 
mimes  for  old  pathologic  conditions.  Some  authors  try 
to  perpetuate  themselves  in  this  way.  We  can  only 
hope  that  most  of  these  new  names  will  be  short-lived. 

The  therapeutics  of  sexual  impotence  has  received 
sonic  valuable  additions,  and  we  have  in  the  method  of 
suspensions  a  frequently  efficacious,  and  in  hypnotic 
suggestion  an  occasionally  efficacious,  remedy. 

It  affords  me  special  satisfaction  that  my  monograph 
has  not  proved  to  be  an  ephemera,  in  spite  of  the  many 
adversaries  the  liberal  interpretation  of  some  pertinent 
questions  lias  encountered. 

THE  AUTHOR. 

SAX  FRANCISCO,  CAL.,  November,  1896. 

9 


CONTENTS. 


CHAPTER  PAGE 

I.- — INTRODUCTION " 17 

II. — ANATOMY 30 

III. — PHYSIOLOGY  OF  THE  SEXUAL  ACT 45 

Sexual  Maturity 45 

Sexual  Orgasm 47 

Seat  of  the  Sexual  Instinct 50 

Erection 51 

Ejaculation 59 

The  Semen 61 

IV. — ETIOLOGY  OF  IMPOTENCE 79 

V. — FORMS  OF  IMPOTENCE    . 87 

Congenital  Malformations  and  Defects  of  the  Sexual  Organs  87 

Absence  of  Penis 87 

Diminutive  Size  of  Penis 88 

Excessive  Size  of  Penis 88 

Absence  of  Prepuce 89 

Superfluity  of  Prepuce 90 

Hypospadiasis 91 

Epispadiasis 91 

Monorchis 92 

Cryptorchis 92 

Hermaphrodites 93 

11 


1  •_>  CONTENTS. 

.11  \I-TKR 

.lry///,v,/  />••/••<•(«  hi  the  Organs  <>f  <;<n<,-«tn,n 93 

A liscnce  of  Penis  and  Testicles '.':; 

Absence  of  Testicles !'l 

Absence  of  One  Testicle 95 

llydrocele  and  Inguinal  Hernia 95 

Changes  in  the  Corpora  Cavernosa 96 

(\nwi-tit\rr  Im/mli-,,,-,- !>7 

Acute  Diseases !>7 

Phthisis 98 

Chronic  Diseases 99 

Diabetes 99 

Obesity 99 

Anemia 100 

Diseases  of  Brain  and  Spinal  Cord 102 

Neurasthenia 103 

Diseases  of  the  Genital ia 108 

Alcohol 113 

Coffee,  etc lie. 

Tobacco 116 

Digitalis 117 

Morphin,  etc 118 

Arsenic 119 

Lead 120 

lodin li'ii 

Mercury 120 

Salicylic  Acid,  Antipyrin,  etc 120 

Inhfi-itfil  Predisposition  tn  /iit/infr/icr 1  ~2'2 

Sexual  Weakness 123 

Incontinence  of  Urine 124 

Frigidity 126 

Nervousness 127 

Perverse  Sexual  Feeling 128 


CONTENTS.  13 

CHAPTER  PAGE 

Neurasthenic  /////«//v//rv    ..............   136 


Excess  in  Venery  ................  137 

After-Effects  of  Copulation     ...........  148 

Sexual  Excesses,  Consequences  of    ........  152 

Fiigidity  ....................  153 

Satiety  of  Ordinary  Sexual  Gratification  ......  154 

Paralytic  Impotence  .......     •   .......  156 

Onaiiisin  ....................  160 

Causes  of  Onanism  ..............  164 

Consequences  of  Onanism  ............  171 

Nervous  Diseases  ................  172 

Pollutions  and  Spermatorrhea   .......        .    .  174 

Endoscopic  Examination,  Results  of    .......  184 

Abstinence  ...................  188 

Irritable  Weakness  ...............  192 

Psychical  Impotence    ..............  195 

Temporary  Impotence      .............  198 

Relative  Impotence  ..............  199 

Professional  Jn>j>otc»ce    ..............  202 

ft-  n  He  Impotence  .................  205 

VI.—  DIAGNOSIS  ...............    ......  209 

VII.—  PROGNOSIS    ....................  214 

VIII.—  PROPHYLAXIS    ...................  216 

IX.—  TREATMENT  ....................  226 

Psychical  Treatment    ...............  228 

Removal  of  Morbid  Influences    ...........  230 

Treatment  of  Spermatorrhea  ...........  230 


1  I  CONTKXTS. 

CIIM-IKI: 


////'//'//'    '  I/'   A/''/////     ................       -'•'<('> 

NniirisliiiH'iil    .................    --"'7 


,  etc.    .   ..............   _';;:i 

I'llMSJlllMI-IIS         ................       I'll) 

Xiix  Ymiiira      .................    _  1  1 


Oninin  ....................    !'»_' 


Valerian 


Cocain  ..........    ..........  -21'.', 

Scincus  Miiriniis     ...............  -2\:\ 

Damiana  ...................  1'44 

Hydrotherapeutics  ...............  244 

Ablutions     .................  :>4<> 

Friction  and  Similar  Proceedings   ........  24(> 

Sponge-Baths  .................  J47 

Douches   ...................  247 

Sitz-Baths    ..............     ...  :M7 

Half-Halhs    ..................  ^4S 

Vapor-Baths    .................  248 

River-  and  Sea-Baths    .............  248 

Balneological  Treatment  ............  24'.i 

Psychrophor    .................  249 

Injections     ..................  250 

Carbon  Douche  ................  2">0 


-  Tin  i-iljn  illicit    ...............     251 

Galvanic  Current    .    .  .    252 


CONTENTS.  15 

R  PAGE 

Electro-  Tlii'i-n/>t:i/Hr.-<.  —  (  'i,nfiii/i«l. 

Faradic  Current  .................  253 

Static  Electricity     ................  254 

Hydro-Electric  Bath  ..............  jr,-t 

Loral  I'ri'iitiiit'tit  ..................  ^")4 

Cauterization  ..................  254 

Astringents  ...................  258 

Bougies  and  Sounds  ...............  2(iO 

External  Applications    ..............  261 

Sinapisms     ...................  261 

Acupuncture  and  Electropunctnre  ........  261 

Surgical  Operations   ...............  261 

M*i**age  and  (»'/////  /></*//Vx    ..............  262 

Trii>-flHii(/     ....................  262 

Flagellation  ....................  263 

Aji/mrnfus  and  Instruments   .............  264 

Regulation  of  the  Sexual  Life   ............  270 

271 


Inhalation  of  Oxygen  ...............  273 

Suspensions  ....................  274 

Hypnotic  Suggestion   ................  277 

X.  —  SPECIAL  THERAPEUTICS     ................  280 


SEXUAL  IMPOTENCE. 


CHAPTER    I. 
INTRODUCTION 

To  write  on  the  much-scouted  subject  of  sexual  im- 
potence is  a  venturesome  undertaking  under  all  circum- 
stances ;  but  to  write  without  the  customary  affectation 
and  hypocritical  rolling  of  the  eyes,  to  speak  the  bare 
truth,  surely  requires  even  greater  courage.  Many  an 
eminent  medical  man  may  have  felt  a  secret  desire  to 
take  the  risk,  but  refrained  from  carrying  out  the  reso- 
lution through  fear  of  endangering  his  professional  repu- 
tation. Some  one  not  counted  among  the  magnates  of 
the  medical  realm  may  feel  licensed  to  plunge  to  the 
very  bottom,  "  to  see  what  the  gods  have  covered  with 
darkness  and  horror,"  and  may  dare  to  relate  to  his 
colleagues  what  he  sees  and  hears,  without  alteration  or 
retouching. 

"  No  physical  or  moral  suffering,  no  wound,  however 
putrid  it  may  be,  should  frighten  him  who  devotes  his 
life  to  the  science  of  man  ;  and  the  sacred  ministry  which 
obliges  the  physician  to  see  everything,  to  know  every- 
thing, gives  him  also  the  right  to  relate  everything." l 

1  Tardieu,  Etude  medico-legale  sur  les  attentats  aux  moeurs. 
Paris,  1878,  p.  2. 

2  17 


18  SKXTAI,    IMI'OTKM  !.. 

It  must  be  admitted  that  the-  subject  has  never  re- 
ceived the  attention  its  preeminent  importance  deserves. 
The  world  over  it  seems  to  be  considered  the  proper 
filing  to  treat  the  affair  with  supercilious  nonchalance. 
Few  medical  men  in  Germany  can  boast  of  ever  having 
had  an  opportunity  to  hear  a  clinical  lecture  on  impo- 
tency;  and  the  complaints  and  criticisms  of  authors 
prove  that  elsewhere  the  subject  receives  no  greater 
favor.  "  The  subject  is  thus  not  yet  emancipated  from 
the  tenacious  grasp  of  the  most  rampant  charlatanism."  l 

"  Let  us  be  frank  from  the  first  steps  of  our  researches, 
because  hypocrisy  is  the  worm  which  in  modern  society 
attacks  and  corrodes  the  highest  and  most  powerful 
plant  of  this  life's  garden.1' 2 

This  somewhat  serious  neglect  is  no  doubt  to  be  at- 
tributed to  the  circumstances  that  those  suffering  from 
impotence  can  hardly  be  subjects  for  treatment  in  hos- 
pitals, and  that  the  observation  of  the  details  and  symp- 
toms of  the  disease  is  attended  with  unusual  difficulties  ; 
nay,  is  hardly  possible  at  all. 

Recent  indications  seem,  however,  to  point  to  a  better 
future.  Men  of  prominence  in  the  learned  world,  with 
Eulenburg,  Krafft-Ebing,  Furbringer,  Edw.  Martin,  and 
some  others  at  the  head,  do  not  think  it  beneath  their 
dignity  to  busy  themselves  with  the  solution  of  the  per- 
plexing problems  of  the  sexual  life,  and  it  is  to  be  hoped 
that  before  long  the  conventional  medical  lies  with  which 
every  book,  every  pamphlet  on  the  subject  is  swarming, 
will  disappear,  and  Mantegazza's  satire 3  become  obsolete. 

'Campbell  Black,  On  the  Functional  Diseases  of  the  Urinary 
and  Reproductive  Organs.  London,  1875,  p.  6. 

2  Mantegazza,  Fisiologia  dell'amore.     Milano,  1882,  p.  75. 
s  Op.  cit.,  p.  298. 


INTRODUCTION.  19 

"  Difficult  problems  cannot  be  solved  if  we  run  away 
from  them  or  if  we  avoid  them  ;  and  still  many  a  physi- 
cian, many  a  philosopher,  tries  to  solve  the  most  burn- 
ing questions  of  modern  society  in  the  manner  of  the 
baby  who  believes  that  he  can  escape  the  threatening- 
dog  by  closing  his  eyes." 

No  one  denies  that  the  sexual  function  is  of  very  great 
consequence  to  the  individual  as  well  as  to  society  in 
general,  although  one  does  not  care  to  make  this  a 
subject  of  conversation. 

"At  any  rate,  the  sexual  function  forms  the  most 
powerful  factor  in  individual  and  in  social  life.  It  is  a 
mighty  impulse  for  bringing  into  action  our  most  effec- 
tive energies,  for  acquiring  property,  for  the  foundation 
of  a  home,  for  rousing  altruistic  feelings  for  a  person  of 
the  other  sex  first,  and,  later,  for  one's  children,  and,  in 
a  wider  sense,  for  the  whole  human  family." l  The  civil 
code  of  Austria  correctly  estimates  the  importance  of 
sexual  virility,  Article  60  declaring  that  "  the  continued 
inability  to  fulfil  the  conjugal  duty  is  a  bar  to  marriage." 
The  criminal  code  (Section  156)  declares,  "  But  if  the 
crime  has  caused  the  loss  of  the  procreative  power  of 
the  injured  man,  then  the  punishment  of  imprisonment 
with  hard  labor  is  to  be  meted  out  for  from  five  to  ten 
years." 

Without  virility  there  can  be  no  procreation.  That  the 
semen  of  impotent  men  frequently  contains  spermato- 
zoa need  not  be  taken  into  account  in  considering  the 
propagation  of  the  race,  and,  generally  speaking,  there 
are  certainly  but  very  few  men  who  owe  their  lives  to 
impotent  fathers. 

1  Krafft-Ebing,  Psychopathia  sexualis.     Stuttgart,  1886,  p.  2. 


20  si:. \r.\l.  IMPOTENCE. 

I  If  win)  lias  become  preinaf  urel  y  impotent  is  one  of 
UK-  must  unfortunate  creatures,  his  jiiisrorlunc  being  the 
greater  as  lie  has  to  be  ashamed  of  it,  must  conceal  it,  is 
pitied  by  no  one,  but  scorned,  and,  alas,  in  exceedingly 
few  cases  can  In-  hope  for  recovery.  I  venture  to  assert 
(hat  in  many  cases  it  is  a  better  deed  to  restore  to  an 
impotent  man  the  power,  so  precious  to  every  individual, 
than  to  preserve  a  dangerously  sick  person  from  death, 
lor  in  many  cases  death  is  preferable  to  impotence. 

The  energy  of  man,  his  courage,  his  enjoyment  of  work 
and  life,  all,  with  hardly  any  exception,  depend  on  his 
sexual  power.  Here  I  leave  out  of  sight  the  sundry  vows 
of  (-hastily  made  by  persons  who  expect  to  be  rewarded 
in  the  hereafter  for  their  voluntary  martyrdom  here 
below.  These  people  hardly  seem  to  be  enjoying  their 
lives,  and  they  call  this  world  a  vale  of  tears.  Now,  this 
world  is  not  exactly  a  vale  of  tears  or  of  grief;  but  let  a 
man  who  has  to  labor  and  produce  from  early  morning 
till  evening,  who  must  day  after  day  begin  ever  anew  the 
struggle  for  existence,  lose  that  little  bit  of  love  and  his 
pathway  will  lead  through  a  vale  of  tears  indeed.  The 
difference  between  the  view  of  things  in  general  formed 
by  old  people  and  that  formed  by  the  young  has  its  only 
explanation  in  the  virility  extinguished  in  the  former  and 
vigorous  in  the  latter.  Prematurely  impotent  people 
very  often  appear  aged  physically,  and  always  mentally. 
Moreover,  we  must  not  forget  that  the  sexual  nervous 
system  is  closely  related  to  all  the  rest  of  the  nervous 
mechanism,  including  those  parts  essential  to  its  physio- 
logical operations.  "  The  feeling  of  sexual  impotence  is 
the  most  humiliating  which  can  ever  afflict  a  man  ;  be- 
cause it  degrades  him  in  his  own  eyes,  and  does  not 
leave  a  single  possible  illusion,  not  a  solitary  moment  of 


INTRODUCTION.  21 

mercy.11  *  Eunuchs  and  the  sexually  impotent  differ  from 
their  fellow-men  who  are  in  full  possession  of  virile  power 
in  appearance  and  in  conduct.  Even  though  executed 
with  talent  and  spirit,  the  work  of  an  impotent  man  bears 
the  stamp  of  impotence. 

In  the  year  1878  I  happened  to  be  in  the  Paris  Salon 
with  one  of  the  most  famous  French  painters.  While 
contemplating  some  paintings,  the  great  master,  to  whose 
wrords  a  crowd  of  artists  were  eagerly  listening,  said, 
"  That  painter  must  be  impotent.11  To  a  question  of 
mine  the  master  replied  that  he  was  able  to  tell  by  a 
picture,  not  only  whether  it  was  painted  by  a  young  man 
or  an  old  one,  but  also  the  condition  of  the  artist's  sexual 
power.  To-day  I  give  full  credit  to  this  assertion,  as  I 
am  convinced  that  with  some  experience  one  can  dis- 
tinguish an  impotent  man  from  a  virile  one  merely  by 
his  looks,  demeanor,  ideas,  words,  and  works. 

The  exterior  of  an  incurably  impotent  man,  whether 
his  impotence  be  real  or  imaginary,  does  not  always  sug- 
gest physical  weakness ;  on  the  contrary,  many  present 
a  very  healthy  appearance,  and  are  stout.  The  keen-eyed 
public  have  baptized  this  corpulency  "  capon-obesity.11 
In  spite  of  the  apparent  healthiness,  the  impotent  man  is 
generally  melancholy,  discontented,  and  peevish.  The 
prematurely  impotent  are,  without  exception,  ill-hu- 
mored, cheered  up  with  difficulty,  and  even  then  for  but 
a  short  time.  Most  of  them  are  grudging,  cowardly, 
envious,  and  wicked.  They  are  all  very  jealous,  as  may 
easily  be  understood.  The  younger  they  are,  the  hand- 
somer their  bodies,  the  higher  their  social  rank,  the  more 
pronounced  is  their  bad  character. 

1  Lallemand,  Pertes  seminales,  tome  ii.,  lre  partie,  p.  132. 


•_>•_>  SEXUAL   I \lhiTK\VK. 

The  character  of  M  man  must.  as  a  mailer  of  course, 
IM-  . ..iisiderably  affected  by  the  consciousness  of  impo- 
tence. No  one  is  more  severe  than  the  impotent  in 
passing  judgment  on  his  neighbor.  No  one  so  ruthlessly 
MI  mercilessly  condemns  a  misdeed,  caused  by  passion, 
against  tin-  very  wise  prescripts  of  Ethics.  Since  he 
cannot  join  the  virile  in  their  enjoyments  of  life,  lie 
makes  a  merit  of  his  incapacity. 

The  striving  of  a  man  to  found  for  himself  a  home,  a 
family,  is  a  stimulus  to  work  and  to  the  accomplishment 
"I  -real  deeds  in  his  sphere  of  life.  Such  a  stimulus 
does  not  stir  the  impotent.  Although  they  do  not  care 
for  life,  yet  they  are  cowards.  It  is  very  seldom  that  an 
impotent  man  turns  dare-devil  and  shows  a  contempt 
for  death,  due  to  despair. 

The  impotent  are  incapable  of  love;  for,  as  Krafit- 
Ebing  says,  "With  all  the  morality  which  love  needs  to 
rise  to  its  true  and  pure  character,  its  most  vigorous  root 
is  nevertheless  sexual  passion.  Platonic  love  is  a  non- 
entity, a  self-deception,  a  wrong  designation  for  cognate 
feelings."1  Similarly,  ambition  is  closely  dependent 
upon  the  sexual  power,  as  it  seldom  makes  its  appear- 
ance before  puberty. 

Finally,  it  must  not  be  forgotten  how  wretched  a  part 
is  played  in  matrimony  and  in  every  other  relation  to  a 
woman  by  the  man  who  is  completely  or  even  partially 
impotent.  He  must  renounce  the  affection  and  regard 
of  a  woman.  Galopin 2  is  quite  right  in  saying,  "  Without 
this  good  friend  (the  woman)  the  dawn  and  evening  of 
life  would  be  helpless,  and  its  mid-day  without  pleas- 


1  Kraffl-Ebing,  Psychopathia  sexualis.     Stuttgart,  1886,  p.  9. 
1  Le  parfum  de  la  femme.     Paris,  1886,  p.  101. 


INTRODUCTION.  23 

ure."  With  all  the  capacity  for  self-sacrifice  which  is 
inborn  with  the  entire  sex,  women  will  nevertheless 
seldom  soar  to  so  high  a  degree  of  self-abnegation  as  to 
love  an  impotent  man.  It  is  the  aim  of  every  husband 
to  hold  a  dominant  position  in  his  family ;  the  more  so 
as  the  weight  of  his  voice  is  less  elsewhere.  My  object 
is  not  to  examine  whether  such  a  position  is  in  the 
interest  of  the  man  himself  and  of  his  family,  but  I  wish 
merely  to  call  attention  to  the  fact  that  the  influence  of 
an  impotent  man  must  be  very  insignificant  with  a 
woman  living  with  him.  whether  she  be  wife  or  mistress. 

I  further  wish  to  point  out  that  many  fallen  women 
would  have  continued  good  and  faithful  had  their  hus- 
bands not  been  more  or  less  impotent.  The  greater 
share  of  sexual  appetite  roused  inconsiderately  or  igno- 
rantly  remains  unsatisfied,  and  much  matrimonial  hap- 
piness is  ruined  by  the  husband's  impotence.  "  Tutavia 
la  compagnia  fra  moglie  e  marito  si  conferma  grande- 
mente  per  questo  atto,  e  non  puo  far  miglior  cosa  il 
marito  per  tenersi  affettionata  e  pacificata  la  moglie. 
die  questa  e  spesso.  Perche  a  questa  foggia,  tutta  la 
casa  sta  in  pace,  e  tranquilla,  e  tutte  le  cose  vanno  bene." 
(Levinio  Lennio.) l 

Now  and  then  impotence  leads  to  suicide.  Marc2 
tells,  for  instance,  of  a  young  man  who,  before  commit- 
ting suicide,  had  written  down  the  words,  "  I  am  impo- 
tent, consequently  I  am  good  for  nothing  in  this  life." 

If  impotence  declares  itself  slowly  and  gradually, 
refuge  is  not  so  often  taken  in  this  safe  though  extreme 
remedy  for  all  diseases  ;  but  is  applied  more  frequently 

1  Mantegazza,  Igiene  dell'amore.     Milano,  1881,  p.  95. 

2  Mantegazza,  op.  cit.,  p.  143. 


1^|  SMXr.M.    I.MI'OTKXCK. 

when  the  c;il;iinily  shows  itself  at  once  and  without  a 
stair  of  transition,  so  that  UK-  patient  understands  plainly 
that  there  is  no  help  for  his  ailment,  and  he  lias  there- 
Core  not  the  time  to  accustom  himself  to  his  misfortune. 
Jlicherand  '  made  the  observation  that  after  penis  ampu- 
tation the  patient  becomes  melancholy,  and  is  conse- 
quently more  subject  to  malignant  wound  fever,  which 
often  causes  death,  whilst  other  mutilations  by  surgical 
operations  are  borne  with  fortitude.  Lallemand2  tells 
of  a  man  forty-five  years  old  who.  after  penis  amputa- 
tion, when  on  the  point  of  leaving  the  hospital,  received 
a  visit,  from  his  wife,  after  which  he  grew  gloomy,  mourn- 
ful, taciturn,  and  died  suddenly.  The  most  careful  au- 
topsy failed  to  reveal  any  cause  of  death  ;  Lallemand 
ascribes  the  fatal  result  to  despair.  In  this  case  the 
patient  had  so  much  the  more  reason  for  despair,  as  the 
sexual  appelite  had  not  vanished  with  the  loss  of  the 
penis.  The  Russian  Skop/.i  after  having  been  maimed 
sutler  a  complete  change  of  character:  they  grow  ego- 
istic, malicious,  hypocritical,  and  covetous.3  It  is  to  be 
observed,  however,  that  surgical  operations  performed 
on  the  genitals  can  cause  genital  reflex  neuroses  in  the 
form  of  melancholia.4 

The  fate  of  being  impotent  is  borne  with  more  stoicism 
when  along  with  the  loss  of  virility  goes  that  of  every  de- 
sire for  intercourse  with  the  other  sex.  Here  again  we 
find  in  Lallemand 5  a  typical  example :  A  man  about 


1  Roubaiid,  Traite  de  1'impuissance.     Paris.  1876,  p.  66. 

2  Op,  cit.,  p.  38. 

*  Mantegazza,  Gli  amori  degli  nomini.     Milano,  188(5.  p.  182. 

4  Kurz,  Zwei   innere  Urethrotomien,  gefulj-'l   vou  Melancholic. 
Ret.  drr  ni.Ml.-rhir.  Mimdschaii.     Wien,  1887,  Heft  xviii.  p.  683. 

5  Op.  cit.,  p.  41. 


INTRODUCTION.  25 

thirty  years  of  age,  who,  in  consequence  of  an  injury  of 
the  occiput,  was  left  without  sexual  appetite,  and  whose 
testicles  were  atrophied,  used  to  talk  in  a  joking  way 
and  quite  merrily  about  his  injury  and  its  sad  conse- 
quences. No  doubt  the  personal  character  is  of  great 
importance  here,  as  each  individual  shows  different 
characteristics  in  the  reaction  following  injury. 

The  impotent  are  misanthropic  and  distrustful.  They 
are  ever  afraid  that  the  defect  of  which  they  feel  ashamed 
may  be  discovered.  All  this  is  aggravated  by  self-re- 
proaches of  the  worst  kind,  for  almost  every  one  be- 
lieves he  has  himself  caused  his  misfortune.  A  reason 
for  self-reproach  is  soon  found,  for  who  has  not  indulged 
in  real  or  imaginary  sexual  excesses  or  self-abuse  ? 

These  people  are  so  much  ashamed  of  their  deficiency 
that  they  will  not  acknowledge  it,  even  to  the  physician, 
except  in  a  most  reluctant  manner.  It  is,  therefore,  ad- 
visable to  meet  the  communications  of  an  impotent  per- 
son with  the  required  scepticism  from  the  very  begin- 
ning. This  sense  of  shame  is  more  intense  with  people 
of  humble  condition  than  with  those  of  a  higher  social 
rank,  who  will  not  infrequently  speak  of  their  impotence 
in  a  joking  tone,  even  where  it  might  not  be  expected, 
in  order  thus  to  make  you  believe  the  contrary.  I  had 
an  opportunity  to  observe  a  case  where  a  member  of  the 
nobility  was  by  every  one  considered  as  impotent.  Under 
the  cover  of  this  reputation  the  nobleman  was  following 
up  several  intrigues,  until  at  last  it  was  discovered  that 
this  impotence  was  not  to  be  relied  upon. 

So  far  we  have  had  under  consideration  the  influence 
of  impotence  upon  the  mind,  and  have  seen  that  it  is  of 
no  slight  degree.  The  influence  of  this  disease  upon  the 
body  is  no  less  important.  We  shall  here  leave  out  of 


26  si:\r.\i.  IMI-MTKNCK. 

sight  circumstances  which  ;iiv  the  cause.  but  not  tin- 
consequence,  of  impotence,  as  well  as  circumstances 
which  may  be  the  consequence  of  spermatorrhea. 

The  cessation  of  so  important  a  process  as  the  sexual 
function  cannot  occur  without  producing  in  and  by  it- 
self an  essential  change  in  the  individual.  According  to 
Arndt,1  there  is  no  disturbance  of  any  function  of  a  man 
without  change  in  the  man  himself.  Real  impotence 
has  a  powerful  influence,  primarily  over  the  mind,  and 
secondarily  over  the  state  of  health  of  the  entire  body. 
It  is  conceivable  that  a  person  who  is  dull  or  mournful 
and  always  ill-humored,  who  is  plagued  by  a  bad  thought, 
must  by  degrees  lose  his  appetite,  suffer  from  indiges- 
tion, and  consequently  must  become  physically  ruined ; 
though,  no  doubt,  one  often  meets,  as  previously  said, 
impotent  persons  looking  thoroughly  well  and  healthy. 

Impotence  besides  being  a  very  serious  disease  is  also 
of  frequent  occurrence.  "  Experience  proves  that  the 
large  towns  especially  harbor  crowds  of  persons  suffer- 
ing from  a  diseased  nervous  system,  who,  in  the  different 
stages  of  life,  are  afflicted  with  sexual  infirmities  which 
throw  a  gloom  over  their  existence.  Youths  who  have 
scarcely  stepped  beyond  the  threshold  of  puberty,  adults 
who  are  on  the  entrance  or  perhaps  in  the  zenith  of 
manhood,  no  less  than  individuals  wrho  have  already 
reached  the  autumn  of  their  lives,  make  up  elements  of 
these  numerous  groups  of  the  sexually  discontented  who 
are  suffering  from  diseases  of  the  nervous  system  as 
burdensome  as  they  are  unyielding.  Victims  of  an  un- 
equal fate,  some  more,  some  less  severely  wounded  in 
the  combat  against  untoward  circumstances, — unequally 

1  Dip  Neurasthenic.     Wien  und  Leipzig,  1885,  p.  3. 


INTRODUCTION.  27 

furnished  with  chances  for  improvement, — all  these  piti- 
able persons  are  nevertheless  animated  with  the  same 
desire,  that  of  being  once  more  admitted  to  the  full  en- 
joyment of  life  and  being  able  to  found  a  family.''1  "  It 
is  quite  incomprehensible  that  there  should  still  be 
physicians  who  almost  absolutely  deny  the  existence  of 
impotence." z 

Every  being  instinctively  longs  for  enjoyment.  The 
desire  for  enjoyment  is  certainly  justified,  and  only  hypo- 
crites or  people  with  limited  views  of  things  in  general 
can  demand  that  man  shall  work  and  fulfil  duties  with- 
out the  moments  of  gladness  and  gratification  that  are  so 
scarce  in  comparison  to  the  bitterness  of  life.  "  La 
nature  veut  que  nous  jouissions.' ' 3 

Sensual  love  and  the  so-called  ideal  love,  which  grows 
out  of  it,  but  which  is  quite  an  impossibility  where  there 
is  no  sexual  vigor,  are  foremost  among  the  few  joys  and 
gratifications. 

Those  who  are  seeking  help  for  their  impotence  are 
surely  very  pitiable  subjects ;  they  feel  themselves  un- 
utterably unhappy,  and,  in  most  cases,  entertain  thoughts 
of  suicide,  though  they  seldom  have  the  necessary  cour- 
age to  carry  them  out.  A  good  man  cannot  refuse  his 
assistance  to  them.  It  cannot  be  the  physician's  business 
to  question  whether  one  or  another  of  them  owes  his 
infirmity  to  his  own  or  somebody  else's  fault.  Nor  can 
it  be  expected  from  the  medical  man  that  he  should  in- 
vestigate what  may  be  the  object  or  aim  of  any  patient 


1  Rosenthal,   Ueber  den   Einfluss   von   Nervenkrankheiten   auf 
Zeugung  und  Sterilitat.    Wiener  Klinik,  1880,  p.  136. 

2  Lionel  S.  Beale,  Our  Morality.     London,  1887,  p.  34. 

3  Renan,  L'abbesse  de  Jouarre.     Paris,  1886,  p.  29. 


28  SEXUAL   IMPOTENT K. 

who  is  endeavoring  to  recover  his  virility.  The  physi- 
cian lias  to  keep  in  view  this  one  object,  that  lie  is  in 
1 1 ir  presence  of  an  unfortunate  person  whom  lie  must 
help  it'  he  can. 

So  much  for  the  determining  of  my  stand-point  and 
to  justify  the  total  separation  of  impotence  and  sterility. 

And  now  the  question  suggests  itself,  Wh«t  i*  intjxt- 
f<  ,,<;•  /  It  is  well-nigh  impossible  to  give  a  precise  answer. 
Maximilian  v.  Zeissl,  for  instance,  gives  the  following 
definition  :  "  Impotency  is  a  collective  idea  of  the  various 
pathological  details  which  hinder  a  man  in  the  carrying 
out  of  coitus,  so  that  the  ultimate  purpose,  viz.,  that  of 
begetting  a  child,  is  not  attained  in  spite  of  sexual  inter- 
course with  a  fertile  woman."  l  This  definition  is  far- 
reaching,  because,  though  we  may  include  both  the  im- 
potentia  coeundi  and  the  impotentia  generandi,  it  should 
yet  be  said  that,  in  spite  of  sexual  intercourse  with  a 
fertile  woman,  the  begetting  of  a  child  "must"  remain 
unattained. 

It  is  much  easier  to  give  a  definition  of  sexual  virility. 
Sexual  virility  is  that  condition  of  the  body,  of  the 
nerves  connected  with  the  generative  organs,  of  the 
centers  of  these  nerves,  and  of  the  genital  organs  them- 
selves, which  enables  an  individual  to  accomplish  the 
sexual  act  with  an  acceptable  woman  always,  under  all 
circumstances,  and  within  the  limits  set  by  nature. 

This  ideal  condition  of  virility  is  somewhat  rare  with 
men  following  the  customary  manner  of  life  of  our  days, 
and  in  any  given  case  it  will  generally  last  for  but  a  short 
time.  Every  deviation  from  this  ideal  condition  must, 

1  Dr.  M.  v.  Zeissl,  Ueber  die  Impotenz  des  Mannes  und  ihre 
Behandlung.  Wiener  med.  Blatter,  1885,  Nr.  15. 


INTRODUCTION.  29 

indeed,  be  reckoned  as  a  starting-point  of  impotence. 
The  lesser  deviations  are  not  taken  into  account,  and 
are  generally  considered  as  in  the  nature  of  things. 

When  virility  is  in  full  vigor  the  sight,  the  slightest 
touch,  the  first  embrace  of  the  desired  woman  must 
cause  sexual  desire  and  the  erection  necessary  to  the 
performance  of  the  act.  The  individual  is  in  the  same 
degree  approaching  impotence  when  he  requires  longer 
preparations  and  longer  and  more  intense  excitation  to 
produce  the  necessary  sexual  rousing.  Of  course,  we 
leave  out  of  question  the  repetition  of  coitus  after  short 
intervals.  The  reverse  of  this  ideal  condition  is  that 
state  which  we  call  total  impotence,  in  which  condition 
the  individual  can  never  have  an  erection  or  experience 
excitement,  and  can,  therefore,  never,  under  any  cir- 
cumstances, perform  the  act  of  coition.  As  nature  never 
progresses  by  leaps  and  bounds,  so  these  two  forms  of 
sexual  capacity  do  not  pass  abruptly  from  one  into  the 
other,  but  between  them  are  numberless  transitory  forms 
of  impotence. 

Although  this  essay  is  written  for  medical  men  only, 
who  are  conversant  with  the  anatomy  of  the  genitals 
and  with  the  physiology  of  procreation,  we  shall  devote 
a  few  pages  to  both  Anatomy  and  Physiology.  In  the 
course  of  years  and  the  throng  of  professional  occupa- 
tions small  matters  escape  the  memory  of  the  practi- 
tioner, and  occasionally  we  may  read  again,  with  profit, 
that  with  which  we  are  well  acquainted. 


CHAPTER    II. 
ANATOMY. 

WE  shall  now  give  a  rough  sketch  of  the  male  organs 
of  reproduction.  For  more  minute  study  we  refer  the 
n  •,  i » ler  to  the  great  number  of  excellent  anatomical  works. 

The  male  genitalia  have  been  divided  into  different 
sections ;  but  as  this  separation  contributes  in  nothing 
to  the  clearness  of  the  subject,  we  shall  simply  discuss 
the  different  organs  in  their  turn. 

The  testicles  (testes,  testiculi,  orchides.  didymi)  arc  a 
pair  of  oviform,  glandular  organs.  We  shall  first  con- 
sider the  coverings  which  protect  and  support  thorn. 
Proceeding  from  the  outside  inward,  we  find  first  the 
outer  skin  starting  from  the  perineum,  from  the  inner 
surface  of  the  upper  thighs,  from  the  root  of  the  penis, 
and  from  the  pubis,  and  forming  the  scrotum  or  purse. 
The  whole  of  the  scrotum  appears  asymmetrical,  hang- 
ing a  little  lower  on  the  left  side.  The  slight  enlarge- 
ment of  the  cutis  forming  the  median  raphe,  which  runs 
from  the  perineum  forward  to  the  inner  surface  of  the 
prepuce  (praeputium),  separating  externally  the  whole 
genital  apparatus  into  two  halves,  and  indicating  the 
inner  division  on  the  scrotum,  is  not  exactly  in  the 
median  line,  but  draws  somewhat  to  the  left. 

At  the  scrotum  we  find  the  epidermis,  cutis,  and 
tunica  dartos.  The  epidermis  is  distinguished  by  the 
amount  of  pigment  it  contains ;  the  cutis,  by  a  strong 

30 


ANATOMY.  31 

growth  of  hair,  sudoriparous  glands,  and  a  rich  rete  of 
lymphatics.  The  tunica  dartos  is  a  fibrous,  fleshy  mem- 
brane, consisting  of  rather  strong,  smooth,  muscular 
fibers,  elastic,  without  fat,  and  ligamentous  in  character. 
Still  proceeding  inward,  we  next  come  to  the  tunica  vag- 
inalis communis,  which  envelops  the  testicle  and  sper- 
matic cord.  That  part  which  surrounds  the  spermatic 
cord  is  loose  and  spongy,  containing  here  and  there 
adipose  tissue,  and  is  intimately  connected  with  the 
spermatic  cord  and  the  scrotum.  This  part  of  the 
tunica  vaginalis  communis  consists  of  three  layers, — an 
inner,  an  outer,  and  a  median  muscular  layer.  These 
layers  or  membranes  are  not  in  all  parts  distinctly  sepa- 
rated from  one  another,  because  the  musculus  cremaster 
which  separates  them  runs  in  isolated  flat  bundles  down 
the  spermatic  cord ;  between  the  bundles  the  two  layers 
run  into  each  other.  These  isolated  flat  fasciae  of  the 
cremaster  pass  in  a  fan-like  manner  downward,  twining 
around  the  testicle.  These  muscular  bundles  have  the 
power  to  draw  the  testicle  upward  and  outward.  Con- 
traction of  this  muscle  ensues  reflexly  from  violent 
movements  of  the  abdomen ;  also  as  the  result  of  inde- 
pendent action.  The  testicle  may,  besides,  be  raised 
through  the  contraction  of  the  muscular  fibers  in  the 
tunica  dartos. 

Immediately  enveloping  the  testicle  we  find  the  tunica 
vaginalis  propria,  which  may  be  divided  into  two  layers, 
— namely,  the  parietal  membrane,  which  is  connected 
with  the  tunica  vaginalis  communis,  and  the  visceral 
membrane,  which  is  united  with  the  albuginea  of  the 
testicle  and  the  epididymis. 

As  the  testicles  produce  the  sperm,  they  are  the  most 
important  part  of  the  male  generative  organs.  The  tes- 


32  SEXUAL   IMPOTENCE. 

lie  Irs  lie  side  by  side  in  the  scrotum,  hanging  down  be- 
tween the  thighs,  below  the  symphysis  pubis,  each  in  its 
own  compartment,  and  separated  from  its  fellow  by  a 
median  membranous  partition, — the  scphnn  *<-roti.  The 
testicles  are  in  the  abdominal  cavity  until  the  seventh 
month  of  fetal  life,  when  they  descend  through  the  in- 
guinal canal  into  the  scrotum. 

The  left  testicle  hangs  a  little  lower,  this  arrangement 
being  very  appropriate,  as  it  prevents  friction  of  the  tes- 
ticles in  case  of  the  sudden  pressing  together  of  the 
thighs. 

In  the  testicle  we  have,  first  of  all,  to  distinguish  be- 
tween the  testicle  proper  (Henle  calls  it  testicular  gland, 
others  call  it  main  or  chief  testicle)  and  the  epidid- 
ymis. 

The  testicles  are  oviform  in  shape,  flattened  laterally, 
with  the  greatest  diameter  four  to  six  centimeters  in 
length,  directed  obliquely  from  above  downward,  for- 
ward, and  outward.  The  weight  of  the  testicle  is  fifteen  to 
24.5  grams,  its  cubic  contents  twelve  to  twenty-seven 
cubic  centimeters,  its  length  five  centimeters,  its  breadth 
2.5  centimeters,  its  thickness  three  centimeters.  Wri^lil 
and  volume,  length  and  breadth,  are  subject  to  great 
variations  in  different  individuals,  and  fluctuate  consid- 
erably even  in  the  same  individual.  In  spite  of  Henle's  * 
opinion  to  the  contrary,  my  experience  teaches  me  that 
this  fluctuation  in  the  volume  of  the  testicle  corresponds 
to  the  amount  of  seminal  fluid  contained.  It  is  true  that 
the  testicle  does  not  collapse  immediately  after  coition, 
but  observation  has  convinced  me  that  the  volume  in- 
creases after  unusual  abstinence ;  so  that  I  feel  sure  that 

1  Handbuch  der  Anatomie.     Braunschweig,  1874,  p,  366. 


ANATOMY.  33 

contraction  of  the  scrotum  is  here  not  the  main  cause 
of  variation. 

Having-  noted  that  the  testicle  is  an  oviform  body  flat- 
tened laterally,  we  observe  further  two  points,  the  upper 
and  the  lower,  and  two  margins  (anterior  and  posterior) 
connecting  them  ;  also  two  flat  surfaces,  an  inner  and 
an  outer.  The  superior  point  and  the  posterior  margin 
are  covered  by  the  epididymis  and  the  beginning  of  the 
seminal  cord. 

Directly  investing  the  testicular  gland  itself  is  the 
tunica  albuyinea.  This  is  a  strong,  fibrous  membrane, 
brilliantly  white,  0.6  millimeter  thick,  containing  nu- 
merous ramifications  of  veins  and  small  arteries,  and 
becoming  considerably  thicker  and  more  vascular  to- 
ward the  posterior  margin.  From  its  inner  surface  it 
sends  off  numerous  bundles  of  connective  tissue,  and, 
at  almost  regular  intervals,  stronger  flat  transverse  bun- 
dles, dividing  the  tissue  of  the  testicle  into  numerous 
conical  lobules,  the  number  of  which  is  placed  by  dif- 
ferent authors  at  from  one  hundred  to  three  hundred. 
Each  lobule  contains  a  great  number  of  very  fine  tu- 
bules, called  xpermativ  canals,  or  vasa  seminalia.  These 
have  a  volume  varying,  according  to  the  degree  of  dis- 
tention,  from  0.1  to  0.2  millimeter.  They  inosculate 
with  one  another,  and  are  very  tortuous,  so  that  it  is 
difficult  to  disentangle  them.  Their  number  is  estimated 
at  eleven  hundred. 

As  we  have  stated,  the  tunica  albuginea  becomes 
much  thicker  toward  the  posterior  margin,  this  enlarge- 
ment forming  what  is  called  the  corpus  Highmori.  Here 
the  seminal  tubes  collect,  three  to  six  inosculating,  and 
grow  less  arid  less  tortuous  until  they  become  almost 
straight  and  form  the  rete  vasculosum  (seu  Halleri)  testis. 

3 


34  SEXUAL  IMPOTENCE. 

From  this  rete  start  about  twenty  larger  tubes  running 
almost  in  a  straight  line,  and  passing  through  the  tunica 
albuginea  into  the  epididymis ;  there  they  form  lobuli 
again,  giving  rise  to  that  single  tube  with  manifold  con- 
volutions which  constitutes,  in  the  main,  the  parenchyma 
of  the  epididymis. 

Besides  the  seminiferous  tubules,  the  parenchyma  of 
the  testicle  contains  comparatively  large  winding  vessels 
with  thick  walls  and  a  cellular  mass,  of  the  function  of 
which  we  still  know  nothing  positive,  and  which  many 
anatomists  and  physiologists  consider  to  be  connective 
tissue.  Before  entering  the  epididymis  the  seminiferous 
tubules  change  in  structure  and  become  simply  excretory 
ducts. 

The  epididymis  properly  considered  is  merely  an 
excretory  duct  of  the  testicle.  It  is  a  body  weighing 
generally  1.5  grams,  its  cubic  contents  being  1.78  cubic 
centimeters.  Its  upper  end  is  globular  in  form  and 
tapers  off  to  pass  into  the  vas  deferens.  The  epididy- 
mis is  also  invested  with  a  tough  albuginea,  which  has 
the  same  structure  as  the  albuginea  of  the  testicle, 
but  is  not  so  thick,  its  thickness  being  only  0.04  milli- 
meter. The  inner  surface  of  the  albuginea  of  the 
epididymis  also  sends  off  septa  of  connective  tissue  into 
the  parenchyma,  dividing  it  into  lobules,  though  super- 
ficially only. 

The  unfolded  vas  epididymis  has  a  length  of  about  six 
meters,  with  a  diameter  of  about  0.44  millimeter,  and 
gradually  dilates  as  it  approaches  the  vas  deferens.  Be- 
sides this  principal  duct,  the  epididymis  contains  also 
one  to  three  small  blind  canals,  the  vasa  aberrantia  and 
the  so-called  hydatis  Morgagni,  which  are  said  to  be 
remnants  of  embryonic  conditions. 


ANATOMY.  35 

At  the  lower  point  of  the  testicle  the  canal  of  the  epi- 
didymis  is  turned  directly  upward  in  order  to  reach  the 
orificium  cutaneum  canalis  inguinalis ;  it  is  then  called 
the  vas  deferens,  and,  together  with  the  vessels  and  nerves 
running  in  the  same  direction,  forms  the  seminal  cord 
(plexus  spermaticus  seu  pampiniformis). 

The  tortuosity  of  the  epididymis  continues  into  the 
first  part  of  the  vas  deferens,  but  the  tube  becomes 
gradually  more  nearly  straight,  its  walls  at  the  same 
time  increasing  in  thickness  and  extent.  The  total 
length  of  the  seminal  vessel  is  about  fifty  to  sixty  centi- 
meters. According  to  Henle,1  the  straight  part  is  about 
three  millimeters  in  diameter,  one- sixth  of  which  is 
taken  up  by  the  lumen,  so  that  the  thickness  of  the  wall 
is  1.5  millimeters.  On  this  thickness  depend  the  firm- 
ness and  cylindrical  form  of  the  vas  deferens. 

Before  the  vas  deferens  unites  with  the  seminal  vesi- 
cle it  forms  the  spindle-like  ampulla  of  Henle.  The 
lumen  in  this  place  becomes  almost  doubled  in  extent, 
the  thickness  of  the  wall  increasing  also.  At  the  end  of 
the  ampulla  the  vas  deferens  grows  thinner  again,  and 
has  outlet  in  the  inferior  pointed  end  of  the  seminal 
vesicle  lying  at  the  outer  part  of  the  base  of  the  urinary 
bladder,  between  the  bladder  and  rectum.  The  end  of 
the  vas  deferens  forms  with  this  pointed  end  of  the 
seminal  vesicle  the  ductus  ejaculatorius. 

The  seminal  vesicles  are  really  hollow  glands  of  a  very 
irregular  form,  resembling  a  very  knotty,  somewhat  flat- 
tened club.  Even  in  the  same  subject  the  two  vesiculae 
seminales  may  differ  in  form  and  size.  The  length  of 
the  vesiculse  seminales  varies  from  four  to  8.5  centi- 

1  Op.  cit.,  p.  382. 


36  SEXUAL  IMPOTENCE. 

meters,  their  diameter  from  0.6  to  0.7  centimeter.  The 
superior  end  is  blunt,  usually  having  a  hump-like  pro- 
tuberance, which,  looked  at  from  the  outside,  resembles 
a  small  hunch.  The  entire  surface  looks  uneven  or 
rough,  the  little  hunch-like  prominences  corresponding 
to  depressions  on  the  inside. 

The  interior  of  the  seminal  vesicles  is  still  more  pecu- 
liar, and  varies  just  like  the  exterior.  The  mucous  mem- 
brane is  of  a  yellowish  tint,  infolded,  has  little  pits,  and 
forms  depressions  and  longer  or  shorter  divertimhr. 
The  organ  has  altogether  a  cellular  appearance.  In  the 
mucous  membrane  there  are  some  peculiar  glands,  which, 
though  the  granular  epithelium  is  different,  have  a  struc- 
ture similar  to  that  of  the  mucous  glands,  but  produce  a 
secretion  essentially  different  from  mucus,  as  it  does  not 
congeal  in  acetic  acid. 

By  the  union  of  the  vasa  deferentia  with  the  vesiculaB 
seminales  the  ejacufatory  dud*  are  formed  about  the 
superior  margin  of  the  prostate  gland,  but  with  number- 
less variations  in  the  share  provided  by  the  individual 
organs  in  this  formation. 

The  parietes  of  the  ductus  ejaculatorius  are  about  0.4 
millimeter  thick,  the  lumen  one  millimeter  in  diameter. 
While  the  lumen  runs  from  two  to  three  centimeters 
forward  and  downward  through  the  prostate,  it  dimin- 
ishes in  volume ;  the  mucous  membrane,  which  at  first 
resembles  that  of  the  vesicula  seminalis,  losing  gradually 
its  folds  and  its  glands,  as  well  as  its  yellowish  tint. 
The  two  ejaculatory  canals  also  frequently  exhibit  varia- 
tions with  respect  to  form,  course,  convergence,  and 
mutual  contact.  Even  coalescence  of  the  two  ducts  into 
one  may  take  place.  The  ejaculatory  canals  lead  into 
the  prostatic  part  of  the  urethra  near  the  verumontanum 


ANATOMY.  37 

or  colliculus  seminalis,  opening  by  circular  mouths.  The 
fact,  minutely  described  by  Henle,1  that  the  muscular 
membrane  of  the  ductus  ejaculatorius  within  the  pros- 
tate assumes  the  character  of  a  cavernous  tissue  seems 
to  me  of  special  importance. 

The  prostate,  shaped  like  a  chestnut  or  flattened  cone, 
embraces  with  its  anterior  surface  the  neck  of  the  blad- 
der and  the  first  portion  of  the  urethra,  its  posterior  sur- 
face resting  on  the  anterior  wall  of  the  rectum.  Its 
texture  is  firm,  the  borders  rounded  off.  The  superior 
border  or  margin  which  surrounds  the  bladder  is 
broader,  slightly  bent  in  the  middle,  while  the  inferior 
margin  tapers  off.  The  greatest  diameter  of  the  pros- 
tata  measures  thirty-two  to  forty-five  millimeters;  from 
the  base  to  the  point  it  is  twenty-five  to  thirty-five  milli- 
meters ;  its  thickness,  fourteen  to  twenty-two  millimeters. 
Its  weight  is  estimated  at  seventeen  to  18.5  grams. 

According  to  Henle,  the  prostate  comprises  three  dif- 
ferent organs,  or,  rather,  structures, — a  number  of  race- 
mose glands,  the  glandula  prostatica  ;  a  closing  muscle  of 
the  bladder,  composed  of  smooth  muscular  tissue,  the 
sphincter  vesicae  internus ;  and  a  transversely  striped 
closing  muscle  of  the  bladder,  the  sphincter  vesica3  ex- 
ternus.  Besides  these,  wre  have  to  notice  in  the  Avail 
of  the  ductus  ejaculatorii,  of  the  sinus  prostaticus,  of 
the  urethra,  and  of  the  colliculus  seminalis,  the  peculiar 
structure  which  sends  off  shoots  into  the  substance  of 
the  prostata  and  also  the  exterior  coat  of  the  glandular 
portion,  together  with  the  separating  walls  or  septa 
starting  from  it. 

The  main  substance  of  the  prostata  is  the  real  gland, 

1  Op.  cit.,  p.  388. 


38  SEXUAL  IMPOTENCE. 

which  does  not  reach  complete  development  until  after 
puberty,  as  the  glandular  ducts  and  vesiculae  develop 
^really  al  the  expense  of  the  substance  of  the  connec- 
tive tissue,  which  predominates  before  puberty.  They 
L:ive  to  the  whole  gland  a  yellowish-red  tint  and  a 
spongy  appearance. 

The  relative  proportion  of  the  muscular  fibers  and  the 
glandular  substance  in  the  prostate  varies  considerably 
in  different  individuals.  In  one  subject  the  glandular 
spaces  may  be  predominant,  and  in  another  their  con- 
Iractible  coatings,  so  that  in  one  person  the  secreting 
function  of  the  prostate  may  predominate,  and  with  an- 
other the  motory.1  Unfortunately,  we  have,  as  yet,  no 
observations  to  determine  what  influence  this  difference 
in  the  structure  of  the  prostata  has  on  the  sexual 
life. 

The  excretory  ducts  within  the  prostata  unite  into  an 
indefinite  number  of  stems,  which  open  into  the  urethra 
at  the  colliculus  seminalis  anterior  to  the  mouths  of  the 
ductus  ejaculatorii.  Two  of  the  largest  stems  open  al- 
most symmetrically,  side  by  side,  quite  close  to  the 
openings  of  the  ductus  ejaculatorii ;  the  others,  from 
seven  to  fifteen  in  number,  open  rather  more  in  front, 
asymmetrically  and  with  variations. 

The  secretion  of  the  prostata  is  of  the  nature  of  mucus, 
but  with  acetic  acid  congeals  but  slightly. 

We  nowr  pass  to  a  short  description  of  the  real  organ 
of  copulation,  the  penis,  which,  with  its  corpora  cav- 
ernosa,  is  perforated  by  the  urethra. 

The  urethra,  which  runs  from  the  neck  of  the  bladder 


1  Riidinger,  Zur  Anatomic  der  Prostata,  des  Uterus  masculinus 
mi«l  der  Ductus  ejaculatorii.     Miinchen,  1883,  p.  4. 


ANATOMY.  39 

to  the  exterior  orifice  of  the  penis,  is  divided  into  three 
portions, — the  pars  prostatica,  pars  membranacea,  and 
pars  cavernosa.  The  course  of  the  urethra  resembles 
the  letter  S, — i.e.,  it  has  two  bends  or  curves,  of  which 
the  posterior  retains  its  shape  even  during  erection. 
The  length  of  the  urethra  varies  very  much,  and  is 
from  fourteen  to  twenty-two  centimeters,  the  pars  pros- 
tatica =  two  to  2.8  centimeters,  the  pars  membranacea 
=  1.50  to  2.50  centimeters,  and  the  pars  cavernosa 
=  10.5  to  16.7  centimeters.  There  is  a  similar  variation 
in  the  lumen  of  the  urethra.  It  is  narrowest  in  the  pars 
membranacea,  and  of  varying  width,  but  least  exten- 
sible, at  the  orificium  externmn. 

In  the  pars  prostatica  the  lower  wall  stands  out,  form- 
ing the  colliculus  seminalis  (caput  gallinaginis,  verumon- 
tanum,  crista  urethralis).  This  is  the  most  important 
part  of  the  urethra,  with  regard  to  the  subject  we  are 
treating,  as  it  is  the  seat  of  many  diseases.  The  caput 
gallinaginis  begins,  according  to  Henle,  at  the  urethral 
mouth  of  the  bladder,  with  two  longitudinal  folds,  con- 
verging toward  the  median  level  space ;  along  with 
these  two  there  is  occasionally  a  third,  the  median  fold. 
The  caput  gallinaginis  may  begin  with  a  greater  number 
of  smaller  folds.  This  crest  reaches  its  greatest  extent, 
in  height  and  breadth,  at  about  the  middle  of  the  pars 
prostatica,  immediately  before  (under)  the  sharp  bend  ; 
it  then  decreases  again  even  less  abruptly,  its  transverse 
diameter  diminishing  at  the  same  time.  The  anterior 
end  extends,  in  the  form  of  a  narrow  ridge,  far  into  the 
pars  membranacea,  and  often  divides,  toward  the  end, 
into  fork-like  branches  at  an  acute  angle. 

This  description  is  very  definite,  indeed,  and  indicates 
clearly  the  great  variations  we  meet  in  the  structure  of 


40  SKMVI,    I.MI'OTKNVK. 

the  crista  urethralis.  These  differences  become  still  more 
numerous  in  consequence  of  disease  or  the  frequent  use 
<>r  instruments.  Age  also  may  have  a  great  inllunire  on 
the  formation  of  this  organ,  so  that  variations  arc  met 
with  at  every  autopsy  as  well  as  at  every  endoscopir 
examination.  The  same  thing  may  be  said  of  the  meas- 
urements of  the  breadth  and  height,  stated  to  be  about 
three  millimeters. 

The  mucous  membrane  of  the  crista  gallinaginis  is 
laid  in  small  creases,  which  open  out  during  erection. 

Besides  the  above-described  openings  of  the  duct  us 
ejaculatorii  and  of  the  excretory  ducts  of  the  prostate, 
we  find  at  the  anterior  slope  of  the  colliculus  seminalis 
a  slender  follicle  without  outlet,  the  sinus  pi-o*f(itiriix 
(Morgagni,  also  utriculus  prostaticus  or  vesicula  pros- 
tatica).  It  can  scarcely  be  determined  what  function,  if 
any,  this  structure  has.  At  any  rate,  the  statement  of 
Riidinger,1  that  the  uterus  masculinus  has  remained 
capable  of  contraction  in  a  very  high  degree,  in  virtue  of 
the  smooth  muscular  fibers,  which  can  be  demonstrated 
in  all  parts,  may  perhaps  seem  to  justify  the  assumption 
that  it  performs  some  functional,  possibly  a  secretory, 
part  or  role. 

The  pars  membranacea  (s.  carnosa,  s.  isthmus)  />/v7///vr 
is  that  part  of  the  urethra  which,  leaving  the  prostata, 
penetrates  into  the  diaphragma  urogenitale  to  enter  the 
corpus  cavernosum  urethra?  at  the  inferior  surface  of 
the  diaphragm  ;  from  this  point  on  it  is  called  the  pars 
cavernosa. 

Next  to  the  posterior  border  of  the  diaphragm,  be- 
tween the  layers  of  the  musculus  transversus  perinaei 

1  Loc.  cit. 


ANATOMY.  41 

profundus,  lie  Cowper's  glands,  belonging  to  the  racemose 
variety.  These  are  two  lobulated  bodies,  resembling  a 
mulberry,  spherical,  sometimes  pressed  flat,  and  meas- 
uring from  four  to  nine  millimeters  in  diameter.  Their 
excretory  ducts,  three  to  six  centimeters  long,  converge 
and  have  their  outlets  close  together  in  the  urethra,  at 
the  end  of  the  bulbous  and  somewhat  dilated  part  of 
the  pars  cavern osa. 

The  mucous  membrane  of  the  cavernous  portion  of  the 
urethra  is  in  longitudinal  folds.  Besides  the  outlets  of 
Cowper's  glands,  it  contains  the  very  fine  glands  of  Littr6 
(0.1  millimeter  average  diameter)  and  the  very  small 
lacunce  Morgagni,  dot-like  in  appearance.  The  lumen 
of  the  urethra  is  dilated  at  both  ends  of  the  cavernous 
portion,  corresponding  to  the  bulbous  part  and  the  fossa 
navicularis. 

The  entire  urethra  is  lined  with  cylindrical  epithe- 
lium, which  in  the  fossa  navicularis,  and  sometimes  a 
little  before,  changes  into  pavement  epithelium.  Within 
the  region  of  the  pavement  epithelium  there  are  papillae 
sometimes  0.22  millimeter  in  height  and  of  diverse  forms. 
Vajda *  declares  that  he  has  discovered  vascular  papillae 
of  sundry  sizes  and  shapes  in  the  whole  mucous  mem- 
brane of  the  urethra,  nearly  as  far  as  the  pars  bulbosa ; 
and  that  the  pavement  epithelium  of  the  fossa  navicu- 
laris extends  over  the  whole  surface  of  the  urethra. 

The  wall  of  the  urethra  consists  of  the  mucous  mem- 
brane, to  which  is  annexed  a  layer  of  areolar  tissue,  the 
meshes  of  the  latter  being  stretched  in  the  longitudinal 
direction  of  the  urethra.  This  areolar  layer  is,  in  the 


1  Beitrage  zur  Anatomie  des  mannlichen  Urogenital-Apparates. 
Wien,  1887. 


42  sK.xr.w,  IMPOTENCE. 

prostatic  part,  the  membranous  part,  and  the  first  por- 
tion of  the  cavernous  part,  enclosed  by  a  layer  of  smooth 
muscular  texture,  with  which  many  elastic  fibers  are 
interwoven. 

The  areolar  tissue,  which  constitutes  the  areolar  layers 
of  the  ductus  ejaculatorii,  the  pars  prostatica  urethra', 
and  the  pars  niemhranacea  urethne,  is  called  by  Henle 
oomtprearibU  an-ulur  ti^nc.  in  contrast  with  the  erectile 
areolar  tissue,  of  which  the  corpora  cavernosa  urethras 
et  penis  consist. 

The  pars  cavernosa  urethra?  is  enveloped  in  a  cylin- 
der of  areolar  tissue,  which,  toward  the  posterior  end. 
gradually  thickens  to  a  club-shape  and  forms  the  so- 
called  bulbus  urethrae ;  while  the  anterior  part  sud- 
denly spreads  out,  covers  the  anterior  ends  of  the  cor- 
pora cavernosa  penis,  and  thus  forms  the  glans  penis. 
Each  of  the  anterior  ends  runs  off  into  a  blunt  point, 
which  is  covered  by  the  anterior  expansion  of  the  corpora 
cavernosa  urethras. 

The  corpora  cavernosa  penis  are  a  pair  of  bodies  of 
cylindrical  shape,  slightly  flattened  on  the  inside.  They 
come  in  contact  in  the  even  median  surface,  while  their 
posterior  ends,  the  so-called  roots,  diverge  and  fasten 
themselves  on  the  inner  surface  of  the  lower  border  of 
the  inferior  branch  of  the  pubis.  The  superior  and  lat- 
eral surfaces  of  the  corpora  cavernosa  can  be  felt  through 
the  outer  skin,  while  the  inferior  surfaces  in  their  contact 
form  the  urethral  furrow  for  the  reception  of  the  corpus 
cavernosum  urethrae. 

We  must  be  brief  in  the  description  of  the  corpora 
cavernosa,  as  details  would  lead  us  too  far.  Each  cor- 
pus cavernosum  has  a  ligamentous,  brilliant  white  tegu- 
ment, consisting  of  connective  tissue  and  elastic  fibers, 


ANATOMY.  43 

in  which  there  are  a  few  very  sinuous  blood-vessels. 
This  cover,  called  albuyinea  of  the  corpora  cavernosa,  is 
about  two  millimeters  thick  when  the  member  is  flaccid, 
but  grows  much  thinner  when  the  corpora  cavernosa  are 
filling. 

From  this  albuginea  proceed  into  the  interior  of  the 
corpora  cavernosa  transverse  vascular  bundles  of  con- 
nective tissue,  consisting  of  elastic  filaments  and  smooth 
muscular  fibers,  and  parietes  or  septa,  with  small  inter- 
stices between.  Thus  is  formed  the  spongy  texture  of 
the  corpora  cavernosa.  These  small  interspaces  are 
coated  with  vein  epithelium  ;  all  are  interconnected  by 
emissaries. 

Henle  asserts  that  these  interspace's  are  vascular  plex- 
uses between  the  ends  of  arteries  and  the  beginnings  of 
veins,  as  neutral  in  character  as  the  capillary  rete  of 
other  tissues.  They  may  be  considered  capillaries  which 
have  dilated  and  run  together  at  the  cost  of  the  inter- 
mediate tissue,  partly  through  atrophy  of  the  latter,  and 
which  have  reduced  the  intermediate  tissue  to  a  number 
of  transverse  bands  and  leaf-like  septa,  in  which  run 
some  supplying  vessels  as  well  as  ordinary  capillaries  of 
the  usual  diameter. 

We  omit  as  unnecessary  a  description  of  the  cutis  of 
the  prepuce,  the  frenulum,  and,  in  a  word,  of  the  exte- 
rior of  the  penis.  Every  physician  is  aware  of  the  indi- 
vidual differences  in  the  volume  of  the  entire  penis,  of 
the  length  and  form  of  the  prepuce. 

The  inner  surface  of  the  prepuce  is  devoid  of  hair, 
smooth,  and  shining.  The  surface  of  the  glans  when 
the  member  is  flaccid  is  slightly  furrowed,  and  conse- 
quently dull  in  appearance  ;  during  erection  it  becomes 
even  and  shining.  There  are  numerous  sebaceous  glands 


44  SEXUAL   IMPOTENCE. 

on  the  arched  surface  of  the  glans,  on  the  prepuce,  and 
around  the  frenulum  ;  moreover,  there  arc  many  papilla1 
HiH'tTing  in  number  and  size.     Sometimes  single  papilla1 
are  found  also  on  the  inner  surface  of  the  prepuce  \vlnn 
it  joins  the  corona. 


CHAPTER    III. 
PHYSIOLOGY  OF  THE  SEXUAL  ACT. 

WE  shall  now  consider  the  male  sexual  functions, 
leaving  fecundation  out  of  the  question,  and  shall  give 
our  attention  to  a  short  sketch  of  the  physiology  of  coitus 
alone,  without  mentioning  the  processes  which  cause 
fecundation.  Besides,  in  the  following  chapters  we  shall 
pay  due  attention  to  the  physiology  of  our  subject. 

It  is  generally  asserted  that,  with  regard  to  procreation, 
nature  has  imposed  on  the  woman  all  the  burdens,  and 
reserved  only  pleasure  for  the  man.  This  is  so,  indeed, 
if  we  take  into  consideration  that  the  woman,  after  con- 
ception, has  to  carry  and  nourish  the  fruit  in  her  body 
for  nine  months  and  then  undergo  the  labor  of  parturi- 
tion. So  far  as  coitus  is  concerned,  however,  in  and  for 
itself,  the  greater  part. devolves  upon  the  man,  and,  more- 
over, in  comparison  with  the  woman,  he  is  at  a  great 
disadvantage.  I  shall  not  dwell  longer  on  this  subject, 
as,  strictly  considered,  it  does  not  enter  into  the  frame- 
work of  our  purpose,  and  I  shall  make  the  man  alone 
the  object  of  my  discussions. 

Sexual  Maturity. — In  order  to  perform  normal  coitus 
the  individual  must  be  in  possession  of  all  the  qualities 
necessary  ;  in  the  first  place,  he  must  have  attained 
puberty.  In  our  climate  males  reach  puberty,  on  an 
average,  at  the  age  of  seventeen.  Puberty  announces 
itself  by  various  exterior  signs,  the  most  striking  being 

45 


46.  SEXUAL  IMPOTENCE. 

the  alteration  of  the  voice,  which  grows  deeper  and 
sounds  rough  and  broken  during  the  period  of  sexual 
development  known  as  the  age  of  puberty.  This  deepen- 
ing of  the  voice  is  caused  by  a  certain  series  of  < -liaises 
in  the  larynx  :  the  processes  vocales  become  cartilaginous, 
the'  larynx  larger  and  protruding,  the  vocal  cords 
lengthened.  Furthermore,  the  bones  and  muscles  grow 
stronger,  the  lungs  larger;  the  pubic  region  becomes 
covered  with  hair.  But  the  greatest  changes  occur  in  the 
genitals,  the  testicles  enlarging  and  beginning  to  secrete. 
The  tissue  of  the  penis,  capable  of  enlarging,  develops 
disproportionately,  and  the  prepuce  loosens  from  the 
glans.  The  sexual  impulse  awakens,  and,  if  not  satisfied, 
results  in  pollutions. 

This  transition  of  the  child  into  a  pubescent  man  re- 
quires about  two  years  for  its  accomplishment.  Thus, 
generally  speaking,  the  young  man  would  be  nubile  ;il 
the  age  of  seventeen. 

Here  I  must  assert  my  opinion,  in  opposition  to  others, 
Roubaud,  for  instance,  who  says  that  spermatozoa  are 
never  found  in  the  semen  of  youths  under  eighteen 
years  of  age.  I  have  repeatedly  discovered  perfectly 
developed  spermatozoa  in  the  semen  of  Frenchmen. 
Italians,  Croatians,  and  Hungarians  hardly  sixteen  ye; us 
old.  I  must  remark,  however,  that  most  of  these  were 
youths  who  sought  for  sexual  gratification  prematurely. 

About  eleven  years  ago  I  performed  the  autopsy  of  a 
sixteen-and-a-half-year-old  shepherd,  who  had  been  a<  •- 
cidentally  drowned,  and  whom  his  comrades  had  de- 
clared to  be  an  onanist.  I  found  in  the  testicles,  as  well 
as  in  the  excretory  ducts,  spermatozoa  in  every  grade  of 
development.  I  also  found  a  great  quantity  of  sper- 
matozoa in  the  semen  of  the  second  pollution  of  a  Croa- 


PHYSIOLOGY   OF  THE   SEXUAL   ACT.  47 

tian  peasant  boy,  who  was  not  quite  sixteen  years  old, 
who  was  not  an  onanist,  and  who  had  not  had  sexual 
intercourse  with  the  opposite  sex. 

The  individual  retains  his  power  to  perform  the  sexual 
functions  during  a  greater  or  less  period  of  his  life. 
There  are  people  who,  in  their  fiftieth  year,  become 
sexually  useless  in  a  quite  normal  manner,  according  to 
constitution,  temperament,  and  habits.  On  the  other 
hand,  it  is  impossible  to  state  any  age  at  which  there 
have  not  been  or  may  not  be  -men  sexually  capable. 
The  procreative  power  is,  however,  most  likely  to  be 
extinguished  after  the  age  of  sixty,  whilst  the  capacity 
for  intercourse  is  certainly  preserved  much  later.  Girault 
found  that  the  spermatozoa  change  after  the  fifty-fifth 
year,  the  heads  growing  larger  and  the  tails  shorter ;  this 
alteration  certainly  not  contributing  to  their  power  of 
movement. 

Sexual  Orgasm. — The  copulative  power  requires  not 
only  that  the  individual  be  virile  and  his  sexual  instinct 
unextinguished,  but  also  that  he  be  capable  of  having 
the  sexual  orgasm  (libido  sexualis),  which  is  a  combi- 
nation of  centrally  or  peripherally  roused  fancies  and 
pleasurable  sensations  associated  therewith.  The  libido 
sexualis  is  very  frequently  in  itself  a  peripheral  excite- 
ment, and  in  the  sexually  virile  the  center  of  erection 
acts  promptly  through  the  afferent  and  efferent  nerves. 
We  shall  see  in  our  future  considerations  that  there  are 
many  cases  where  the  impotence  is  merely  a  consequence 
of  complete  or  incomplete  absence  of  sexual  excitement. 
We  shall  see  that  anything  capable  of  distracting  the 
sexual  excitement  at  the  given  moment,  to  divert  the 
run  of  ideas  from  the  sexual  track,  is  also  capable  of 
causing  sexual  impotence,  be  it  only  for  the  moment. 


48  s  i:\r..\L  IMPOTENCE. 

\Vliiit  is  il.  then,  speaking  generally,  that  can  cause 
the  sexual  orgasm  ?  If  tlie  human  male  is  left  to  him- 
self and  nothing  comes  to  disturb  the  natural  course,  lln- 
first  sexual  rousing  will  not  occur  until  he  has  reached 
tin-  state  of  full  sexual  maturity;  when  the  testicles, 
spermatic  ducts,  and  vesiculae  seminales  are  filled  with 
sperm.  This  first  sexual  excitement  would  occur  even 
if  Hie  individual  should  have  no  idea  of  sexual  things, 
whirh,  probably,  would  be  exceptional.  This  is  a  proof 
that  the  accumulation  of  sperm  in  the  seminal  organs 
may  and  must  occasion  sexual  excitement  quite  inde- 
pendently of  the  will  of  the  individual.  On  the  other 
hand,  we  see  that  sexual  excitement  takes  place  with 
persons  whose  seminal  organs  are  anything  but  full  of 
sperm.  It  is  evident  that  here  the  sexual  excitement 
comes  about  through  mental  impressions.  The  center 
for  mental  impressions  is  in  the  cortex  cerebri.  There- 
fore sexual  excitement  may  be  caused  through  the  me- 
dium of  the  cortex  cerebri,  and  this  is  generally  the  case. 

We  see  individuals  whose  sexual  sense  is  deadened  in 
such  a  wise  that  the  psychical  impressions  alone  can  no 
longer  bring  about  sexual  rousing.  Such  people  have 
generally  no  sperma  in  their  spermatic  organs  to  cause 
the  rousing,  and  yet  they  are  known  to  accomplish  coi- 
tion. It  is  well  known  that  these  persons  are  in  the 
habit  of  putting  themselves  into  a  state  of  sexual  excite- 
ment by  irritating  the  exterior  part  of  the  organ,  and 
sometimes  have  recourse  to  the  most  loathsome  manipu- 
lations. 

Indeed,  we  see  that  the  most  diverse  irritations,  prac- 
tised on  the  outer  and  the  inner  nerves  of  the  sexual 
organs,  cause  libido  sexualis.  Thus,  for  instance,  inci- 
dental friction  of  the  genitals  by  too  tight  garments,  the 


PHYSIOLOGY  OF  THE  SEXUAL  ACT.  49 

introduction  of  a  sound  or  a  catheter,  an  inflammatory 
or  catarrhal  condition  of  the  urethra,  pressure  of  a  full 
bladder  or  of  the  rectum,  anal  fissures  or  hemorrhoidal 
ulcers,  irritation  by  worms  or  by  urine  containing  some 
medicinal  or  certain  alimentary  substances, — all  these 
may  cause  hyperemia  or  secondary  libido  sexualis. 

Finally,  it  is  known  that  from  the  most  diverse  organs 
sexual  erethism  can  be  aroused ;  above  all,  from  the 
organs  of  the  senses,  particularly  the  organs  of  sight, 
touch,  and  smell.  It  must  be  observed,  however,  that 
these  cause  sexual  excitement  indirectly  only,  by  means 
of  the  central  organ,  the  cortex  cerebri.  The  sight  of  a 
beautiful  woman,  the  touch  of  certain  parts  of  the  body 
of  a  woman,  the  agreeable  odor  of  a  woman,  a  lascivious 
picture,  all  are  apt  to  bring  about  sexual  excitement,  but 
only  in  so  far  as  such  impressions  on  the  senses  give 
rise  to  some  idea  or  recollection  in  the  central  organ. 

Sexual  excitement  may  arise,  therefore,  in  three  dis- 
tinct ways:  (1)  reflexly  and  naturally,  through  the  ac- 
cumulation of  sperm  in  the  seminal  organs,  in  which 
case  there  is  no  intervention  of  the  cortex  cerebri,  the 
seat  of  sensation  and  ideation ;  (2)  psychically, — the 
most  frequent  way, — through  ideas,  consequently  through 
the  activity  of  the  cortex  ;  and  (3)  unnaturally,  by  means 
of  direct  excitation  of  the  sexual  organs. 

I  leave  out  of  question  here  single  and  rare  cases,  in 
which  it  is  pretended  that  the  sight  of  an  object  in 
no  way  related  to  sexual  things,  odors  certainly  not 
coming  from  a  woman,  the  touch  of  objects  not  in  any 
relation  with  woman,  the  eating  of  certain  food  not 
physically  aphrodisiac,  or  even  impressions  on  the  sense 
of  hearing,  have  produced  sexual  excitement.  Obser- 
vations of  this  nature,  if  they  do  not  belong  to  the  prov- 

4 


50  SEXUAL  IMPOTENCE. 


of  table  or  arc  not  based  upon  error,  can  be  made 
only  upon  individuals  psychically  abnormal,  and  in  most 
cases  can  be  traced  to  fancies  or  recollections. 

Thus  we  see  that  in  sexual  matters  the  (•<>,•!<.<•  <•<,-<  •/>/  -i 
n/nl  tlic  xcxual  organs  are  in  nnifiKif/i/  <!(  /,<  n</<  ,if  rcf<ifitinx. 
Ideas  and  desires  which  originate  in  the  cortex  cerebri 
act  upon  the  sexual  organs  through  the  medium  of  other 
centers  situated  in  the  lumbar  region  ;  on  the  other 
hand,  certain  occurrences  in  the  sexual  organs,  princi- 
pally such  as  accumulation  of  sperm,  create  images  and 
ideas  of  a  sexual  nature  in  the  cortex  cerebri,  which 
may  seem  unaccountable  to  an  inexperienced  person,  but 
which  result  in  libido  sexualis. 

Seat  of  the  Sexual  Instinct.  —  II  has  not  yet  been 
discovered  which  part  of  the  cortical  substance  is  the 
scat  of  the  se.rual  ind'uicf.  Besides  the  center  of  excite- 
ment there  must  be  a  center  of  inhibition,  which,  with 
people  who  have  learned  to  control  themselves,  is  de- 
veloped in  a  higher  degree,  and  puts  a  kind  of  check  on 
the  libido  sexualis.  It  is  probable  that  this  inhibitory 
center  does  not  exist  in  animals  at  all,  and  is  but  slightly 
developed  in  people  on  a  low  moral  plane.  However, 
this  inhibitory  center,  often  very  beneficent,  has  also  its 
disadvantageous  side.  In  the  numerous  cases  of  sexual 
neurasthenia  called  by  various  names,  the  <  -ause  lies  in 
the  untimely  interference  of  this  inhibitory  center. 

The  XC.I-IHI/  rtijKfrifi/  of  an  individual  depends  mostly 
on  the  facility  with  which  lie  can  be  brought  into  a  state 
of  sexual  excitement.  Lively  and  excitable  men,  who  are 
easily  and  on  every  occasion  thrown  into  sexual  excite- 
ment, are  more  prone  to  excesses  in  venery,  andvall  other 
conditions  being  equal,  accomplish  more  in  this  respect 
than  phlegmatic,  cold  natures,  with  whom  it  requires  a 


PHYSIOLOGY   OF  THE   SEXUAL   ACT.  51 

concurrence  of  several  circumstances  in  order  to  produce 
sexual  erethism.  This  fact  explains  also  the  well-known 
sensuality  of  artists,  to  which  attention  was  called  in  the 
Graef  case  at  Berlin,  and  which  derived  a  more  conclu- 
sive proof  from  the  prudish  protest  of  the  artists  them- 
selves. 

Erection. — Sexual  irritation  causes  the  erection  of  the 
virile  member.  An  erection  may,  however,  take  place 
without  the  excitement  by  reflex  action ;  but  such  an 
erection  is  not  sufficient  for  coitus  without  the  addition 
of  sexual  erethismus.  We  apply  the  term  erection  to 
that  physiological  process  which  puts  the  virile  member 
into  the  condition  that  enables  it  to  make  its  way  into 
the  vagina. 

We  shall  now  direct  our  attention  to  what  takes  place 
in  erection.  In  the  chapter  on  Anatomy  we  have  de- 
scribed the  structure  of  the  penis,  and  we  have  seen  that, 
from  the  tunica  albuginea  of  the  three  erectile  bodies, 
vascular  transverse  fasciae  and  septa  run  into  the  inner 
part  of  the  corpora  cavernosa,  leaving  small  interstices, 
thus  converting  the  corpora  cavernosa  into  spongy  bodies. 
These  small  hollow  interspaces  of  the  three  corpora 
cavernosa  are  coated  with  endothelium  resembling  that 
of  the  veins,  and  are  consequently  venous  spaces. 
Numerous  emissaries  keep  all  the  corpora  cavernosa  in 
communication  with  one  another,  and  open  out  into  the 
vena  dorsalis  and  the  vena  profunda  penis.  In  the  base 
of  the  penis  there  are  the  arteriae  helicinae,  which  are 
wound  in  the  shape  of  a  ram's  horn,  in  order  that  they 
may  yield  to  the  changes  of  volume  in  the  erectile  tissue. 
It  is  now  clearly  demonstrated  that  erection  is  caused  b'y 
a  filling  of  these  spaces  with  blood,  but  the  entire  pro- 
cess of  erection  in  man  is  nevertheless  far  from  being 


;,-_>  SKXUAL  IMPOTENT!-;. 

explained.  The  researches  on  this  subject  by  Kolliker, 
liou-el,  L.niiici.  Eckhard,  Goltx,  Loven,  and  Frey  are 
hi- lily  meritorious,  it  must  be  admitted,  but  the  wrr/m ///*/// 
n/  erection  has  still  its  mystery. 

We  know  that  erection  is  the  result  of  an  increased 
influx  of  blood  into  the  areolar  tissue  of  the  corpora 
cavernosa,  together  with  a  decreased  outflow  of  blood 
from  the  same  bodies  ;  but  we  are  far  from  understand- 
ing the  cause  of  that  afflux,  often  quite  sudden,  and  of 
that  checking  of  the  outflow.  At  first  an  attempt  was 
made  to  explain  the  process  by  the  macroscopic  ana- 
tomical relations.  It  was  supposed  that  either  the  outer 
transversely  striped  muscles  or  the  inner  smooth  mus- 
cles exercise  a  pressure  on  the  efferent  veins.  Kolliker's 
opinion  was  that  the  relaxation  of  the  smooth  muscles 
caused  erection.  Opposed  to  this  opinion  is  the  theory 
that  the  smooth  muscles  in  the  walls  of  the  cavernous 
spaces  do  not  possess  alone  sufficient  strength  and 
energy  to  influence  erection  to  such  a  degree ;  for 
when  the  nervus  dorsalis  penis,  which  innervates  the 
transverse  fibrous  bands  of  the  areolar  tissue  of  the 
penis,  has  been  severed  the  erectile  power  is  reduced. 
Eckhard  has  even  painlessly  irritated  the  nervous  dorsalis 
penis  of  dogs  under  chloroform  without  producing  an 
erection  ;  nor  has  an  erection  ensued  after  the  excitalion 
of  the  central  end  of  the  severed  nervus  pudendus  coin- 
munis  of  a  dog.1  If  it  were  not  for  these  experiments, 
much  might  be  said  for  the  opinion  of  Kolliker ;  for,  if 
these  muscles  were  powerful  enough,  their  contraction 


1  Eckhard,  Ueber  den  Verlauf  der  Nerven  erigentes  innerhalb  des 
Rttckenmarke  und  Gehirns.  Beitrage  zur  Anatomie  und  Physi- 
ologic, Band  vii.  Heft  1,  p.  70. 


PHYSIOLOGY   OF   THE   SEXUAL  ACT.  53 

would  certainly  prevent  an  erection.  On  the  other  hand, 
the  fact  that  warmth  causes  a  dilatation  and  cold  a  con- 
traction of  the  corpora  cavernosa  speaks  with  some  force 
for  the  influence  of  the  smooth  muscles.  However,  this 
is  not  sufficient  for  an  explanation  of  erection,  and  con- 
sequently other  theories  regarding-  the  physiological  pro- 
cess of  erection  have  always  been  sought.  Thus,  Eck- 
hard  obtained,  through  his  experiments  upon  animals, 
the  following  results  :  Erection  can  be  caused  in  rabbits 
by  faradization  of  the  lumbar  and  cervical  regions  of  the 
cord,  the  pons  Varolii,  and  the  peduncles  of  the  cerebrum, 
while  irritation  of  the  cerebellum  alone  has  no  such 
effect.1  Eckhard  is  therefore  of  the  opinion  that  the  seat 
of  erection  is  in  the  cerebrum,  and  that  the  nerves  which 
bring  about  erection,  starting  from  the  cerebrum,  run 
downward  in  the  medulla  spinalis. 

Goltz,  in  his  experiments  upon  dogs,  cats,  and  rabbits, 
found  that  erection  can  be  caused  by  excitation  of  the 
glans,  bladder,  and  rectum,  even  after  the  spinal  cord 
has  been  severed  at  the  upper  border  of  the  lumbar 
region,  and  that  it  is  also  possible  to  cause  ejaculation  of 
sperma  after  destruction  of  the  lumbar  region  of  the 
cord,  even  though  the  capability  of  erection  has  been 
entirely  extinguished.2 

The  result  of  these  experiments  on  animals  corre- 
sponds with  clinical  observations  in  cases  of  injuries  and 
diseases  of  the  spinal  cord.  Further  experiments  have 
shown  that  in  the  cerebrum  and  in  the  uppor  portion  of 
the  spinal  cord  there  must  be  inhibitory  nerves  affecting 

1  Eckhard,  op.  cit.,  p.  77. 

2  Goltz,  Ueber  die   Functionen  des  Lendenmarks  des    Hundes. 
Pfliiger's  Archiv  fiir  die  gesammte  Physiologic,  Band  viii.  Heft  8 
u.  9,  p.  464. 


;-,  I  SKXTAL   IMPOTENCK. 

eiv<  lion;  because,  alter  section  of  the  cord  at  the  upper 
border  of  the  lumbar  region,  croc-lion  can  be  caused 
more  easily  and  more  vigorously  by  means  of  electric 
irritation. 

\\'e  have  sreii  Dial  erection  is  caused  by  afflux  of  arte- 
rial blood  and  an  obstructed  outflow  of  venous  blood. 
Krection  cannot,  however,  be  brought  about  by  mere 
compression  or  ligation  of  the  veins.  That  an  increased 
flow  of  arlerial  blood  takes  place  is  proved  by  the  lower- 
ing of  the  blood-pressure  in  the  neighboring  inguinal 
arteries,  and  even  as  far  as  the  artoria  crural  is.  as  shown 
by  the  manometer.  How  this  increased  arterial  afflux 
is  caused  is  not  yet  explained.  Certainly  the- accelera- 
tion of  the  heart's  action  which  always  takes  place 
during  sexual  erethism  can  have  but  a  very  slight  influ- 
ence. Possibly,  the  arteries  of  the  penis,  in  consequence 
of  the  sexual  erethism,  become  dilated,  and  thus  admit 
more  blood.  The  question  is,  Has  this  erethism  a  para- 
lyzing influence  on  the  muscles  of  the  walls  of  the  vessels, 
or  is  it  an  invigorating  effect,  causing  the  contractions 
to  become  more  energetic  and  more  frequent,  and  the 
arteries  to  pump,  so  to  speak,  a  greater  quantity  of  blood 
into  the  mesh-like  spaces  of  the  penis  ? 

Goltz  endeavors  to  explain  the  act  in  this  way :  "  I 
share  the  opinion  of  those  who  compare  the  connection 
of  the  nervi  erigentes  with  the  penis  to  that  of  the  vagus 
with  the  heart,  or  the  chorda  tympani  with  the  vessels 
of  the  glandula  submaxillaris.  The  progress  of  blood 
through  the  penis  is  considerably  hindered  during,  the 
time  of  physiological  rest ;  for  then  the  small  arteries  of 
the  penis  and  other  vascular  spaces  are  in  a  state  of  mod- 
erate contraction.  Very  likely  this  state  of  tension  or 
firmness  of  the  vessels  of  the  penis  is  maintained  by  the 


PHYSIOLOGY   OF  THE   SEXUAL   ACT.  55 

action  of  the  small  ganglia  whose  presence  in  the  penis 
has  been  proven  by  Loven.  The  pressure  of  the  in- 
going blood  dilates  the  arteries ;  when  the  resistance  is 
removed  the  blood  flows  more  freely  through  the  areolar 
tissue  into  the  erectile  bodies,  and  puts  them  into  a  state 
of  turgescence.  Being,  then,  with  Loven,  inclined  to 
consider  the  peripheral  ganglia  the  tonic  center  of  the 
vessels  of  the  penis,  we  must  suppose  that  the  nervi 
erigentes  during  their  activity  paralyze  or  check  these 
ganglia  in  the  same  way  that  the  vagus  checks  the  activity 
of  the  ganglia  of  the  heart."  *  Goltz  saw  this  opinion 
confirmed  by  the  fact  that  he  succeeded  in  proving  ex- 
perimentally that  reflex  erection  of  the  penis  could  be 
prevented  by  a  more  intense  irritation  of  the  nervus 
ischiadicus.2 

Such  experiments,  if  continued,  will  no  doubt  at  some 
future  time  result  in  a  complete  explanation  of  the  mech- 
anism of  erection,  though  for  the  present  the  practi- 
tioner can  obtain  but  unimportant  benefits  from  the 
above  researches. 

Experience  teaches  us  that  erection  can  be  either 
caused  or  checked  by  different  impressions  from  the 
most  varied  parts  of  the  body.  It  is  certain,  however, 
that  the  cerebrum  is  the  place  of  origin  of  the  sensations 
of  sexual  excitement.  With  this  higher  center  is  con- 
nected, by  intercentral  nerve-channels,  an  inferior,  me- 
chanical reflex  center,  which  has  its  seat  in  the  lumbar 
region  of  the  cord,  and  governs  the  performance  of  the 


1  Goltz,  op.  cit.,  p.  466. 

2  Compare  :  Prof.  Dr.  A.  Spina  (Prague) :  Experimentelle  Bei- 
trage  zu  der  Lehre  von  der  Erection  und  Ejaculation.    Wiener  med. 
Blatter,  1897,  No.  10-13. 


56  SEXUAL  IMPOTENCE. 

act  of  copulation.1  It  is  probable  that  from  tin-  spinal 
cord  issue  some  special  nerves  which  straighten  the 
erectile  vessels  or  else  diminish  their  extensibility.2 

When  erection  is  accomplished,  the  penis  is  in  a  con- 
dition that  makes  penetration  possible.  We  shall  now 
direct  our  attention  to  the  process  of  coitus.  Roubaud  5 
describes  it  as  follows :  "  The  moment  the  membrum 
virile  enters  the  vestibulum,  the  glans  penis  rubs  itself 
first  against  the  glandula  clitoridis,  which  is  situated  at 
the  orifice  of  the  sexual  canal,  and  can  yield  and  bend 
in  consequence  of  its  place  and  of  the  angle  it  forms. 
After  this  first  excitement  of  the  two  centers  of  sensa- 
tion, the  glans  penis  glides  over  the  borders  of  the  two 
bulbi ;  the  collum  and  corpus  penis  are  enveloped  by 
the  prominent  parts  of  the  bulbi,  while  the  glans,  having 
penetrated  deeper,  has  come  into  contact  with  the  line 
and  delicate  surface  of  the  mucous  membrane  of  the 
vagina,  which  itself  is  elastic  by  virtue  of  the  erectile 
tissue  between  the  membranes.  This  elasticity,  which 
enables  the  vagina  to  surround  the  body  of  the  penis 
closely,  also  increases  the  turgescence  and,  consequently, 
the  sensibility  of  the  clitoris,  by  conducting  the  blood, 
driven  out  of  the  vessels  of  the  vaginal  walls,  to  the 
bulbis  and  clitoris.  On  the  other  hand,  the  turgescence 
and  sensibility  of  the  glans  penis  are  heightened  by  I  he 
compressive  action  of  the  tissue  of  the  vagina  and  <>f  the 
two  bulbi  in  the  vestibulum,  which  tissue  becomes  more 
and  more  turgescent.  Moreover,  the  clitoris,  pressed 
downward  by  the  anterior  portion  of  the  musculus  com- 


1  Goltz,  op.  cit.,  p.  473. 

1  Eckhard,  op.  cit.,  p.  80. 

8  Traite  de  1'impuissance  et  de  la  sterilite.     Paris,  1876. 


PHYSIOLOGY   OF  THE   SEXUAL  ACT.  57 

pressor,  meets  the  dorsal  surface  of  the  glans  and  cor- 
pus penis,  and  causes  friction.  This  mutual  friction  at 
every  motion  during  copulation  affects  both  individuals, 
and  leads  finally  to  that  high  degree  of  orgasmus  which 
induces,  on  the  one  hand,  the  ejaculation,  and,  on  the 
other,  the  reception  of  the  seminal  fluid  in  the  open 
orifice  of  the  neck  of  the  uterus. 

"  The  question  has  been  asked — and  many  earnest 
investigators  have  tried  to  answer  it — whether  the 
greater  share  of  pleasure  falls  to  the  man  or  the  woman 
in  these  moments  of  the  greatest  intoxication.  This 
question  has  received  the  most  contradictory  explana- 
tions, like  all  questions  that  rest  on  essentially  different 
and  varying  bases.  Indeed,  taking  into  consideration 
all  the  circumstances  which  influence  the  sexual  sense, 
I  do  not  believe  that  it  is  possible  to  solve  the  problem 
a  priori.  If  we  consider  how  much  the  sexual  sense  is 
influenced  by  the  temperament,  the  constitution,  and 
a  great  many  other  circumstances,  special  as  well  as 
general,  we  shall  be  convinced  that  this  question  is  far 
from  being  solved — nay,  is  insoluble  ;  and  this  is  so  true 
that  we  meet  with  difficulties  even  if  we  want  to  draw  a 
true  and  perfect  picture  of  coitus :  while  with  one  indi- 
vidual the  sensation  of  voluptuousness  manifests  itself 
merely  by  a  slight  quivering,  it  will  reach,  with  another, 
the  climax  of  exaltation,  moral  as  well  as  physical.  Be- 
tween these  two  extremes  there  are  innumerable  grada- 
tions. Increased  rapidity  of  the  circulation  of  the  blood, 
violent  pulsation  of  the  arteries,  the  retention  of  venous 
blood  in  the  vessels  by  the  contraction  of  the  muscles,  in- 
creases the  general  warmth  of  the  body.  The  stagnation  of 
the  venous  blood  becomes  still  more  decided  in  the  brain, 
on  account  of  the  contraction  of  the  muscles  of  the  neck 


58  SI. XTAL   IMPOTKXCK. 

;ind  because  the  head  is  bent  backward.  All  this  causes 
a  Iransitory  congestion  of  the  brain,  during  which  reason 
ami  all  the  mental  facilities  an-  lost.  The  eyes,  reddened 
by  the  injection  of  the  conjunctiva,  become  staring,  the 
look  becoming  unsteady;  or,  as  is  more  generally  Hie 
case.  Die  eyes  close  convulsively  to  avoid  contact  with 
light.  The  respiration  is  gasping  with  some,  whilst  with 
others  it  is  interrupted  by  a  spasmodic  contraction  of 
the  larynx;  and  the  air,  compressed  fora  time,  forces 
an  issue  at  last,  in  connection  with  disconnected  and  in- 
comprehensible words.  The  nerve-centers,  as  was  just 
said,  give  confused  impulses :  movement  and  sensation 
are  in  indescribable  disorder:  the  limbs  are  seized  by 
convulsions,  sometimes  also  by  cramp  ;  they  move  in  all 
directions,  or  stretch  themselves  and  grow  as  stiff  as  bars 
of  iron  ;  the  jaws,  pressed  together,  make  the  teeth  gnash ; 
and  some  individuals  go  so  far  in  their  erotic  delirium  as 
to  bite  to  bleeding  a  shoulder  that  the  partner  may  have 
exposed  incautiously. 

"  This  frantic  condition,  this  epilepsy,  this  delirium, 
generally  lasts  only  a  short  time,  but  sufficiently  long  to 
exhaust  completely  the  strength  of  the  organism,  espe- 
cially with  the  man,  where  this  hyperexcitation  ends 
with  a  more  or  less  abundant  loss  of  sperm.  Then  fol- 
lows a  state  of  exhaustion,  the  intensity  of  which  is  in 
proportion  to  that  of  the  previous  excitement.  The 
sudden  weariness,  the  general  weakness,  the  inclination 
to  sleep,  which  take  hold  of  the  man  after  copulation, 
are  to  be  ascribed  partly  to  the  expulsion  of  spenna ; 
because  the  woman,  however  energetically  she  may  have 
co-operated  in  the  act,  feels  only  a  passing  lassitude, 
which  is  far  less  than  the  weariness  of  the  man,  and  which 
allows  her,  after  a  much  shorter  lapse  of  time,  to  repeat 


PHYSIOLOGY   OF  THE  SEXUAL  ACT.  59 

the  act.  '  Triste  est  omne  animal  post  coituni,  praeter 
mulierem  gallumque,'  says  Galien,  and  this  axiom  is, 
in  substance,  correct  as  far  as  the  human  race  is  con- 
cerned. 

"From  this  moment  the  further  function  of  generation 
is  not  attended  with  consciousness ;  the  part  of  the  man 
is  at  an  end,  and  the  woman  begins  now  to  bring  her 
capabilities  into  action." 

I  have  quoted  entire  this  classic  description  of  the  act 
of  copulation,  although  I  cannot  agree  with  all  the  details 
expressed.  The  mechanical  act  being  so  universally 
known,  further  comment  on  it  is  quite  superfluous ;  in- 
deed, it  would  be  difficult  to  say  anything  new  or  differ- 
ing from  that  already  related  by  Roubaud.  It  would 
seem,  however,  incorrect  to  assume  that  the  hyperemia 
of  the  clitoris  should  depend  on  anemia  of  the  vaginal 
walls  caused  by  the  friction  of  the  penis.  If  the  act  is 
normal — that  is,  if  there  is  not  too  great  a  disproportion 
in  the  size  of  the  respective  genital  parts — there  cannot 
possibly  be  any  such  pressure  exerted  on  the  vaginal 
walls  as  to  cause  an  anemia,  on  account  of  the  great 
elasticity  of  the  tissue.  This  observation  is  merely  made 
incidentally,  as  this  point  does  not  enter  into  a  consider- 
ation of  our  subject. 

Ejaculation. — Coitus  ends,  for  the  man,  with  ejacu- 
lation, after  which  the  erection  gives  way  in  most  cases. 
Occasional  exceptions  occur,  however,  though  this  is 
contrary  to  the  usual  opinion.  With  particularly  vigor- 
ous men  the  relaxation  of  the  member  is  not  so  rapid, 
and  an  immediate  repetition  of  the  act  is  possible,  and  is 
actually  practised  by  men  who  do  not  care  particularly 
about  cleanliness.  If,  after  ejaculation,  the  man  con- 
tinues the  movements  of  coitus,  it  is  done  generally  out 


60  SEXUAL  IMPOTENT!', 

of  gallantry  toward  the  partner;  all  that  the  man  wauls 
after  ejaculation  is  rest. 

Of  coitus  it  may  be  said  with  full  justice.  "  Finis  coro- 
nal opus,"  for  ejaculation,  the  end  of  the  act,  is  also  its 
most  essential  and  decisive  part.  The  process  in  ejacu- 
lation has  been  observed  to  some  decree,  but  only  in 
animals.  The  effect  of  the  friction  on  the  sensitive  glans 
is  communicated  to  the  musculi  ischiocavernosi,  called 
by  Visale  erectores  penis,  and  to  the  musculi  bulbocaver- 
nosi,  which  contract  and  convey  more  and  more  blood 
to  the  glans.  This  superabundance  of  blood  invades  the 
prostate  and  the  neck  of  the  bladder  also,  thus  com- 
pletely closing  the  bladder.  By  the  continued  irritation 
the  contents  of  the  ductus  ejaculatorii,  the  prostata,  and 
the  seminal  vessels  are  expelled,  these  fluids  combined 
constituting  the  ejaculated  sperma.  It  is  probable  that 
the  muscles  of  the  prostata  and  of  the  pars  membranacea 
contract  first,  and  then  are  immediately  followed  by  the 
musculi  ischiocavernosi  and  bulbocavernosi,  which  are 
much  stronger  and  constitute  the  principal  element  in 
ejaculation. 

The  center  for  ejaculation  has  been  proven,  by  Budge, 
to  be  at  the  level  of  the  fourth  lumbar  vertebra. 

With  the  contraction  of  the  prostata  begins  an  in- 
tensely voluptuous  sensation,  but,  in  case  the  move- 
ments of  coitus  cease  here,  the  ejaculation  can  be  re- 
tained, which  possibility  is  frequently  taken  advantage  of 
by  persons  expert  in  coition. 

Ejaculation  takes  place  also  in  nocturnal  pollutions. 
Here  the  excitation,  caused  by  other  conditions,  leads  also 
to  a  contraction  of  the  muscles,  and  if  the  sleeper  awakes 
before  the  musculi  ischiocavernosi  and  bulbocavernosi 
are  contracted,  he  may  prevent  the  issue  of  semen. 


PHYSIOLOGY   OF   THE   SEXUAL   ACT.  61 

Ejaculation  is  accompanied  by  an  intensely  pleasur- 
able sensation,  which  is  dependent  on  the  exciting  of 
the  sensitive  terminal  branches,  or  rami,  of  the  nervus 
pudendus  running  out  into  the  glans.  A  number  of  these 
rami  end  in  the  genital  nerve-bulbs.  The  bulbi,  irritated 
by  the  friction  against  the  stretched  surface  of  the  glans, 
covered  with  delicate  skin,  lead  this  irritation  toward 
the  center. 

Ejaculation,  as  we  have  seen,  is  the  physiological 
process  by  means  of  which  the  sperm  is  sent  forth  to- 
ward the  mouth  of  the  uterus. 

The  Semen. — We  must  now  turn  our  attention  finally 
to  the  product  of  the  male  genital  organs, — viz.,  the 
semen. 

Hippokrates  considered  that  the  whole  body  was  em- 
ployed in  the  production  of  the  semen.  We  know  that 
this  fluid  is  a  mixture  of  the  products  of  sundry  glands 
within  the  sexual  apparatus  of  the  male,  and  that  it  con- 
sists of  the  secretions  of  the  testicles,  the  epididymes, 
the  vasa  deferentia,  the  seminal  vesicles,  Cowper's  glands, 
and  the  prostata. 

Ebner  has  very  thoroughly  studied  the  process  of  the 
preparation  of  the  sperma  in  sections  of  the  testicles 
of  rats,  and  found  that  it  proceeds  from  special  cells, 
ending  in  lobules,  and  advancing  like  columns  toward 
the  inner  portion  of  the  canal.  The  cells  are  called 
spermafoblasts. 

Within  a  seminal  canal  are  to  be  found,  at  the  same 
time,  all  the  different  degrees  of  spermatic  formation  ; 
all  the  forms  of  development  repeat  themselves  about 
twice  within  the  space  of  from  ten  to  fourteen  millime- 
ters. 

Landois,  who  worked  at  the  same  time  and  indepen- 


62  SEXUAL  IMPOTENT  I  ]. 

dri illy  of  Ebner,  obtained  the  same  result.  He  calls 
these  spermatoblasts  spermatic  ears  or  spikes.1 

Many  dittnvul  views  prevail  with  regard  to  details  in 
the  preparation  or  production  of  spernia,  and  this  sub- 
ject is  far  from  having  a  satisfactory  explanation.  Quite 
new  are  some  results  to  which  von  Bardeleben  came  in 
I  lie  course  of  his  researches,  which,  if  confirmed,  will 
revolutioui/.e  all  our  views  upon  the  subject. 

The  seminal  ro/'y>//.s-r/rx  are  the  product  of  the  testicles. 
Every  corpuscle  shows  three  characteristic  portions, — 
viz.,  a  head,  a  middle  piece,  and  a  tail.  The  head  is 
stained  by  canniu,  and  therefore  is  to  be  considered 
the  nucleus.  The  middle  piece  has  the  form  of  a  deli- 
cate little  rod,  or  of  a  cone,  and  connects  the  head  with 
the  thread-like  tail.  This  middle  piece  is  stained  by 
iodin  more  than  is  the  head.  The  whole  semen  cor- 
puscle measures  0.051  millimeter,  of  which  the  head 
forms  0.005,  the  middle  piece  0.006,  and  the  tail  0.04. 

The  tail  is  the  principal  motor  organ  of  these  sper- 
matozoa, the  mechanism  of  motion  being  explained  dif- 
ferently by  different  investigators.  The  energy  of  motion 
of  the  individual  corpuscles  is  variable.  Hensen2  esti- 
mates the  time  of  half  an  oscillation  at  at  least  one- 
quarter  of  a  second  during  the  continuance  of  full  vital 
power.  The  rapidity  of  the  movement  forward  is  be- 
tween 1.2  and  '2.7  millimeters,  or,  according  to  others, 
3.6  millimeters  per  minute. 

The  semen  corpuscles,  formed  in  the  testicles,  remain 


1  Landois,  Lehrhuch  der  Physiologie.  Wien  und  Leipzig,  1893, 
p.  1012. 

2  Physiologie  der  Zeugung.  Hermann's  Handbuch  der  Physi- 
ologie, Band  vi.  Theil  2,  p.  92. 


PHYSIOLOGY  OF  THE  SEXUAL  ACT.  63 

there  until  they  are  discharged  in  the  usual  manner  of 
seminal  expulsion.  It  is  hard  to  believe  that  spermato- 
zoids  once  formed  are  reabsorbed.  There  are,  it  is  true, 
some  isolated  observations  which  seem  to  support  the 
idea ;  as,  for  instance,  Schweiger  observed  spermatozoids 
of  a  young  ram  undergoing  granular  decay ;  this  and 
Kehrers  experiments  in  applying  ligatures  to  the  vas 
deferens  of  rabbits  are  well-known  cases.  Finally,  as  a 
curiosity,  may  be  mentioned  the  reabsorption  of  urine 
in  the  bladder,  described  in  the  British  Medical  Journal.1 

Recently  the  question  of  the  absorptive  power  of  the 
bladder  has  been  ventilated  cum  studio,  but  somewhat, 
also,  cum  ira.  While  Alapy2  comes  to  the  conclu- 
sion that  absolutely  nothing  can  be  absorbed  by  the 
bladder  itself,  Hottinger's3  experiments  seem  to  prove 
the  contrary.  If  we  remember  that  a  limited  absorp- 
tion can  be  accomplished  even  by  the  skin,  it  is  hard 
to  understand  why  the  intact  bladder  should  not,  under 
favorable  circumstances,  be  able  to  absorb"  to  some 
extent. 

Dr.  Gerota,  of  Bucharest,4  showed  by  a  series  of  micro- 
scopic plates  that,  while  there  was  imbibition  on  the 
part  of  the  mucous  lining  of  the  bladder,  there  was  no 
real  active  absorption. 

The  philosophical  discussions  of  Gosselin,  Haller,  and 
others  show  only  that  these  men  had  no  correct  con- 
ception of  the  sexual  functions  of  the  man. 

1  Black,  On  the  Functional  Diseases  of  the  Urinary  and  Repro- 
ductive Organs.     London,  1875,  p.  157. 

2  Centralblatt  fur  die  Krankheiten  der  Harn  und  Sexual  Organe, 
1896,  p.  328. 

3  Ibidem,  p.  333. 

*  Medica-l  Record,  September  18,  1897. 


64  SKXITAL  IMPOTKMT, 

To  me  this  theory  of  reabsorption  of  semen  is  com- 
parable l<»  Ihe  notion  that  a  cold  can  be  caused  by  the 
absorption  of  perspiration,  which  Hebra,  in  his  lectures, 
ridiculed  whenever  an  occasion  arose.  Hensen1  says, 
in  referring  to  the  above,  "We  require  better  proofs  to 
establish  a  normal  decay.  Decaying  of  elements  in  UK 
sperma  would  of  necessity  be  so  unprofitable,  even 
dangerous,  for  the  race  that  some  contrivance  to  excrete 
them  would  long  since  have  formed."  Hensen  thinks 
that  the  sperma,  being  slowly  formed,  will  gradually  be 
driven  or  pushed  out  of  the  ductus  ejaculatorius,  in  case 
pollutions  alone  do  not  favor  the  continued  renewal  of 
sperma.  Hensen,  therefore,  supposes  a  physiological 
spermatorrhea.  This  also  is  an  assumption  which 
would  likewise  require  demonstration.  I,  myself,  during 
I  In-  years  1884  to  1888,  made  observations  on  this  sub- 
ject, and,  although  they  may  not  constitute  a  conclusive 
argument  against  Hensen's  assumption,  I  will  state  them 
as  an  incentive  to  further  investigations. 

During  two  years  I  have,  with  special  care,  repeatedly 
examined  the  urine  and  urethral  mucus  of  two  perfectly 
healthy  and  vigorous-men,  aged  twenty-nine  and  thirty- 
four,  who  were  absolutely  continent  and  had  had  no 
seminal  emission  ;  and  I  have  never  found  even  a  trace 
of  spermatozoids.  The  younger  of  these  men,  a  clergy- 
man, submitted  to  this  examination  on  account  of  a 
friendship  of  long  standing  between  us  and  his  love  of 
science.  Before  the  first  discharge  of  urine  in  the 
morning,  for  seventy-five  successive  days,  I  examined 
carefully,  with  the  microscope,  the  urethral  mucus, 
which  was  small  in  quantity,  and  then  every  discharge 

1  Op.  cit.,  p.  93. 


PHYSIOLOGY   OF  THE   SEXUAL  ACT.  65 

of  urine  ;  but  never  found  as  much  as  a  trace  of  a  sper- 
nmlozoid.  I  lay  especial  stress  upon  this  as  opposed  to 
the  assertions  of  Black,1  who  states  that  he  had  frequently 
found  seminal  filaments  in  the  urethral  mucus  after 
alvine  evacuations  in  healthy  men. 

The  above-mentioned  man,  thirty-four  years  of  age, 
had  been  married,  but  his  wife  died  of  phthisis  six  years 
before  I  began  my  observations  upon  him.  He  had  lost 
his  two  children  by  diphtheria  in  the  same  year.  The 
unfortunate  man  grew  melancholy  and  for  some  time 
felt  no  sexual  desire.  Later  on  he  had  pollutions  and 
violent  sexual  desires ;  but  he  overcame  them,  and  after 
four  years  of  absolute  continence  he  seldom  had  erec- 
tions in  the  mornings,  and  thought  no  longer  of  sexual 
passions.  He  asserted  that  formerly  he  had  been  vigor- 
ous in  coitus  and  had  indulged  daily. 

The  twenty-nine-year-old  man  had  masturbated  at 
wide  intervals  from  the  age  of  sixteen  to  twenty-three. 
He  struggled  against  this  "  sinful  practice,"  as  he  called 
it.  with  all  the  power  of  his  exceptionally  strong  char- 
acter. He  finally  mastered  his  passion.  For  two  years 
his  occasional  pollutions  grew  less  frequent,  and  for  three 
years  past  he  has  had  no  emission  of  sperm  in  any 
way  ;  sexual  desire  visits  him  seldom,  though  he  has 
erections  every  morning. 

Still  more  characteristic  is  the  following  observation. 
A  professor  at  a  university,  thirty-nine  years  old,  and  of 
large  and  powerful  build,  has  been  married  for  fourteen 
years,  enjoying  good  health.  His  wife,  often  sickly,  dis- 
inclined to  sexual  intercourse,  is  absent  for  months ; 
hence  a  forced  continence  for  long  periods.  As  soon  as 


1  Op.  cit.,  p.  63. 
5 


66  SEXUAL  IMPOTENCE. 

this  goes  beyond  a  month  there  appears  a  slight  but 
painful  swelling  of  the  testicles.  He  finds  himself  com- 
pelled to  indulge  in  sexual  congress  at  any  cost,  during 
which  he  emits  unusually  large  quantities  of  sperm,  and 
the  swelling  and  pain  in  I  lie  testicles  vanish  as  if  by 
magic. 

I  claim  no  conclusive  credit  for  the  above  three  obser- 
vations ;  but  they,  together  with  a  number  of  others,  of 
which  I  may  have  to  speak  in  connection  with  impotence 
as  a  result  of  continence,  confirm  me  in  the  opinion  that 
sperm  once  formed  will,  if  it  is  not  expelled  in  any  of 
the  usual  ways,  at  first  hinder,  and  finally  stop,  the  pro- 
duction of  new  semen.  It  would  indeed  be  interesting 
to  know  what  becomes  of  this  stored-up  semen.  The 
only  chance  for  clearing  up  this  question  would  seem  to 
be  an  autopsy  of  persons  who,  after  long  continence, 
have  died  suddenly ;  but  such  an  opportunity  will  sel- 
dom be  offered.  The  third  observation  of  these  three 
individuals  seems  to  prove  that,  in  some  cases  of  conti- 
nence at  least,  the  production  of  semen  is  not  only  not 
retarded  but  actually  increased,  so  that  the  accumulation 
of  sperm  becomes  so  great  that  it  causes  the  testicles  to 
swell  and  become  painful. 

What  is  commonly  called  semen  consists  of  the  sper- 
matozoids,  formed  in  the  testicles,  to  which  are  added 
the  secretions  of  several  glands  situated  in  the  terminal 
portion  of  the  vasa  deferentia,  the  so-called  ampulla ; 
there  is  added  also  the  secretion  of  the  walls  of  the 
vesiculae  seminales.  The  latter  are  not  real  glands  but 
canals ;  their  inner  surface  is  much  increased  by  folds 
and  villi,  and  their  secretion  helps  mostly  in  diluting  the 
sperm. 

It   does   not  seem   to   me   satisfactorily   determined 


PHYSIOLOGY   OF  THE  SEXUAL  ACT.  67 

whether  the  vesiculce  geminates  are  secreting  glands  or 
merely  receptacles  for  the  sperm.  The  new  experimen- 
tal researches  about  the  physiology  of  the  seminal  vesi- 
cles by  Rehfisch  *  are  very  interesting,  but  do  not  reveal 
any  important  or  new  points.  It  is  probable  that  the 
vesiculae  seminales  and  the  ampulla?  of  the  vasa  defer- 
entia  have  two  functions, — viz.,  to  serve  as  receptacles, 
and  to  produce  an  albuminous  secretion  that  attenuates 
the  sperm.  The  contents  of  the  ampullae  and  of  the 
vesicular  seminales  of  fresh  cadavers  have  all  the  char- 
acteristics of  ejaculated  sperm,  but  are  poorer  in  sperma- 
tozoids.  Henle 2  endeavors  to  explain  this  fact  by  sup- 
posing that  at  the  last  moment  of  coitus  that  portion  of 
the  vas  deferens  nearest  to  the  ampulla  evacuates  its 
contents  more  quickly. 

To  the  semen,  attenuated  as  above  described,  is  later 
added  the  secretion  of  the  prostata  and  of  Cowper's 
glands. 

Eckhard  obtained  by  irritation,  from  the  prostata  of  a 
dog,  a  secretion  which  had  the  specific  gravity  of  1.012, 
one  per  cent,  of  albumen  and  2.4  per  cent,  of  solid 
constituents. 

The  relation  of  the  prostata  with  its  secretion  to  the 
semen  is  not  clearly  demonstrated,  as  it  is  still  a  ques- 
tion whether  the  secretion  of  the  prostata  is  added  at 
all  to  the  seminal  fluid.  Henle3  is  quite  right  when 
he  says  that  the  seminal  fluid  in  the  ampullae  of  the  vasa 
deferentia  and  in  the  vesicula?  seminales,  although  closely 
resembling  the  ejaculated  semen,  is  poorer  in  sperma- 


Deutsche  rned.  Wochenschrift,  1896,  No.  16. 
Op.  cit.,  p.  389. 
Op.  cit.,  p.  401. 


<;s  SEXUAL  IMPOTENCE. 

toxoids.  Hence  what  needs  explanation  is  not  an  atten- 
uation of  the  semen,  hut  an  actual  increase  in  sperma- 
loxoids.  llenle  says  further:  u  It  is  scarcely  reasonable 
to  suppose  that  the  function  of  the  proslala  is  In  aid  n- 
ualr  the  semen,  as  the  principal  mouths  of  the  prostatic 
duds  are  situated  behind  the  summit  of  the  colliculus 
scininalis,  and  'the  latter  seerns  to  shut  off  the  urethra 
during  erection.  Finally,  as  far  as  my  knowledge  ex- 
tends, the  concentric  concretions,  which  are  seldom 
wanting  in  Hie  ^lamlnla  prostatica  of  old  men,  and  which 
are  often  found  in  the  outlets  of  the  prostata,  arc  not 
found  in  the  ejaculated  semen." 

Henle  asks,  "Is  'the  prostata  connected  perchance 
with  erection,  and  does  it  furnish  the  mucous  fluid  which 
oozes  from  the  mouth  of  the  urethra  after  continued 
erection  ?" 

Finally,  it  is  held  that  the  mucus  of  Co trj ><>•'.•<  </f(m<l« 
unites  with  the  sperm,  but  Henle1  thinks  that  Cowper's 
glands  do  not  add  their  secretion  to  the  sperm,  and  are, 
therefore,  not  to  be  reckoned  among  the  organs  of  the 
sexual  apparatus,  but  of  the  urinary  apparatus.  Beyond 
doubt  these  glands,  together  with  the  mucous  glands 
proper  of  the  urethra,  make  provision  for  the  moisture 
and  lubricity  of  the  urethra,  and  thus,  in  any  case,  aid 
in  ejaculation,  and  perhaps,  as  Hensen 2  conjectures,  clear 
the  urethra  of  remains  of  urine,  which  have  an  acid 
reaction  and  kill  the  spermatozoa.  Besides  this,  we 
must  not  forget  that  Cowpers  glands  are  perfectly  devel- 
oped in  infancy. 

Let   us   direct   our  attention   now  to  the  ejaculated 


1  Op.  cit.,  p.  413. 

2  Op.  cit.,  p.  101. 


PHYSIOLOGY  OF  THE  SEXUAL  ACT.  69 

The  quantity  and  quality  vary  greatly  in  dif- 
ferent individuals,  as  well  as  in  the  same  individual,  the 
differences  being  determined  by  the  variable  productive- 
ness of  the  glands,  which  differ  in  the  same  manner  and 
degree  as  their  products,  for  reasons,  some  known  and 
some  unknown. 

Mantegazza1  finds  the  quantity  of  ejaculated  semen 
of  a  thirty- year-old  man,  weighing  about  eighty  kilo- 
grams, to  be  between  0.75  and  6.0  cubic  centimeters. 
Ultzmann 2  estimates  the  average  quantity  for  a  moder- 
ately living  man  at  ten  to  fifteen  grams. 

It  is  to  be  regretted  that,  in  connection  with  the  above 
figures,  there  are  no  indications  how  these  ejaculations 
have  been  brought  about,  because  those  from  pollutions 
are  considerably  less  in  quantity  than  those  in  coitus. 
This  fact,  which  has  never  yet  been  noted,  may  be 
explained  in  this  way  :  the  vesicular  seminales  and  sper- 
matic ducts  do  not  always  empty  their  contents  into 
the  urethra  at  the  same  time,  and  it  may  be  that  when 
the  excitation  is  moderate  only  one  of  the  receptacles 
empties  itself.3 

The  measuring  of  the  quantity  ejaculated  during  coitus 
is  an  impossibility,  since  the  quantity  is  less  when  the 
coitus  is  prematurely  stopped  or  interrupted,  as  in  the 
cases  known  as  "  frauding,"  or  "  coitus  interruptus." 
This  may  explain  why  the  so-called  "  fraudeurs"  can  at 
first  accomplish  coitus  oftener  than  those  who  follow 
nature,  and  why  the  same  individual  when  he  begins 


1  Ricerche  sullo  sperma  umano.    Gazzetta  medica  Italiana  Lom- 
bardia,  1886,  Nr.  34. 

2  Ueber   Potentia    generandi    und    Potentia   coeundi.     Wiener 
Klinik,  1885,  Heft  1,  p.  2. 

3  Landois,  op.  cit.,  p.  1024. 


70  SEXUAL  IMPOTENCE. 

frauding  can  repeat  the  act  more  frequently  than  when 
he  does  not  cheat  nature  in  this  way.  The  bad  effects 
of  frauding,  also,  which  Bergeret1  paints  in  colors  de- 
cidedly too  gloomy,  may  here  find  their  explanation. 
There  are  cases,  nevertheless,  where  long-continued 
frauding  has  undoubtedly  weakened  the  sexual  souse. 
I  have  pbserved  this  repeatedly  within  the  last,  few  years. 
The  sexual  sense  soon  recovers  when  frauding  is  dis- 
continued. 

The  ejaculated  sperm  is  a  colorless,  opalescent  fluid, 
in  appearance  resembling  boiled  starch.  The  seminal 
filaments  on  their  way  from  the  testicles  to  the  rneatus 
urinarius  externus  are  joined  by  the  products  of  sundry 
glands,  and  thereby  assume  certain  characteristics,  the 
odor  of  chestnut-blossom  or  newly  sawn  bones  being 
peculiar  to  the  main  substance  formed  in  the  testicles. 
The  alkaline  reaction  comes,  possibly,  from  the  secretion 
of  the  prostata ;  the  color,  from  the  admixture  of  the 
secretion  of  the  vesiculae  seminales ;  the  gluey  consist- 
ency, from  the  secretion  of  Cowper's  glands. 

The  seminal  liquid  is  heavier  than  water,  soluble  in 
water  and  acids,  and  coagulable  by  alcohol.  Colorless, 
brittle  crystals  separate  from  it  when  it  has  been  stand- 
ing for  a  long  time,  the  process  being  somewhat  more 
rapid  when  the  sperm  has  been  placed  in  ice,  or  when 
inspissated.  Vauquelin's  chemical  analysis  is  as  follows  : 

Water 90 

Organic  substance 6 

Earthy  phosphates 3 

Sodium  chlorid  .  1 


1  Des  fraudes  dans  Taccomplissement  des  fonctions  generatrices. 
Paris,  1884. 


PHYSIOLOGY   OF  THE  SEXUAL  ACT.  71 

The  consistency  of  the  sperm  changes  soon  after  ejac- 
ulation, becoming  more  nearly  liquid. 

Whether  or  not  a  fluid  is  sperm  can  be  proven  only 
by  microscopic  examination.  Sperm  under  the  micro- 
scope shows  seminal  corpuscles,  granules,  cells,  and 
epithelia  from  the  prostata  (?)  and  urethra.  If  the  sperm 
comes  from  coitus,  it  also  contains  pavement  epithelium 
from  the  female  genitals. 

Frequent  indulgence  will  both  diminish  the  quantity 
and  impair  the  quality  of  the  sperma.  Differences  have 
been  observed  in  this  with  respect  to  individuals  and  to 
time,  and  I  can  myself  assert  as  a  result  of  numerous 
observations  that  habit  and  sexual  vigor  are  the  main 
agents  producing  such  differences. 

The  presence  of  spermatozoa  determines  the  fertilizing 
power  of  the  semen.  The  sperma  of  a  vigorous  man  in 
a  state  of  perfect  virility  shows  under  the  microscope  a 
very  animated  life  picture,  which  Ultzmann  very  appro- 
priately compares  to  the  life  exhibited  by  an  ant-hill. 
The  spermatic  filaments  are  seen  to  shoot  across  the 
field  of  vision  like  arrows,  making  movements  that  seem 
anything  but  aimless,  so  that  it  is  not  to  be  wondered 
at  that  they  were  at  first  thought  to  be  animalcules. 

This  animation  is  most  lively  in  newly  ejaculated 
semen,  and  grows  calmer  in  proportion  as  the  sperma- 
tozoa die  ;  but,  if  the  sperma  be  preserved  under  favor- 
able circumstances,  some  of  the  filaments  may  be  seen 
alive  even  at  the  end  of  forty- eight  hours.  They  are 
killed  by  urine  and  the  vaginal  mucus,  which  has  an  acid 
reaction.  Mantegazza1  found  that  the  spermatozoa  re- 
tain their  vitality  in  temperatures  varying  from  15°  to 

1  Loc.  cit. 


72  SKXUAL  IMPOTENCE. 

47°  C.  Heating  above  47°  or  freezing  holow  lo°  kills 
them.  It  was  further  discovered  that  these  filaments  re- 
main vital  in  frozen  semen  as  long  as  six  days,  possibly 
even  longer.  Slightly  alkaline  fluids,  such  as  blood,  favor 
the  life  of  the  spermatozoids.  Such  fluids,  as  \vell  as 
concentrated  solutions  of  salt,  sugar,  and  albumen,  are 
capable  of  reviving  spermatozoids  that  are  already 
motionless.  Water  destroys  motion  after  an  hour,  at  the 
latest ;  but  they  are  very  lively  in  purulcnl  sperm  ;  con- 
sequently they  are  not  affected  by  pus. 

The  dead  spermatozoids  show  various  figures  of  the 
lifeless  tail.  In  those  that  die  after  ejaculation  it  is 
stretched  out  or  slightly  bent ;  whilst  in  those  that  are 
ejaculated  dead  it  is  spirally  wound  up.  but  seldom 
broken.1 

Most  authors  adduce  various  experiments,  the  results 
of  which  have  led  to  an  opinion  riot  wholly  correct,— 
viz.,  that  frequent  coition  reduces  the  number  of  sperma- 
tozoids, and  daily  coition  makes  them  disappear  alto- 
gether. To  these  investigators  I  can  oppose  many  ob- 
servations, where,  after  coition  repeated  daily  several 
times,  the  sperma  still  contained  numerous  spermato- 
zoids. These  observations  were  made  in  the  years 
1884-1888.  The  differences  in  the  results  of  the  o/>wr- 
vationscan  easily  be  explained,  inasmuch  as  examinations 
made  on  old  men  lead  to  different  conclusions  from  those 
made  on  vigorous  and  perfectly  virile  young  men. 

Before  I  refer  to  some  of  my  own  observations,  I  wish 
to  observe  that  of  necessity  it  has  not  always  been  possi- 
ble to  make  the  microscopic  examinations  immediately 
after  coition,  nor  at  an  equal  length  of  time  after  copula- 

1  Compare  Ultzmann,  op.  cit.,  p.  4. 


PHYSIOLOGY  OF  THE  SEXUAL  ACT.  73 

tion  ;  and,  furthermore,  the  frequency  of  coition  could 
not  be  regulated  by  the  investigator.  The  sperma  was 
invariably  taken  in  the  largest  quantities  possible,  and 
was  preserved  in  glass  tubes,  which  were  sealed  and  so 
placed  that  neither  air  nor  light  could  affect  the  contents. 
All  the  microscopic  examinations  were  made  with  a  No. 
3  ocular  and  a  No.  7  objective  of  a  Wetzlar  microscope. 

OBSERVATIONS    ON    SUBJECT    NUMBER    ONE. 

A  vigorous  and  perfectly  healthy  man,  twenty-nine 
years  old,  who  performed  coition  on  an  average  once  a 
day.  The  microscopic  examinations  gave  the  following 
results : 

From  October  1  to  October  9  one  coition  per  day ;  on 
October  9,  examination  of  sperma  nine  hours  after  co- 
ition ;  result,  few  spermatozoids,  mostly  dead,  not  well 
developed;  but  the  few  still  moving  are  very  lively, 
although  mostly  young  forms. 

October  10. — One  coition  ;  sperma  not  examined. 

October  11. — Sperma  examined  eleven  hours  after  co- 
ition ;  result,  few  spermatozoids,  all  dead. 

October  12. — Examination  nine  hours  after  coition  ; 
no  spermatozoids. 

October  IJf.. — Coition  after  a  lapse  of  forty-nine  hours  ; 
examination  eight  hours  afterward  ;  result,  about  thirty 
spermatozoids,  few  alive,  movement  slow  but  very  ener- 
getic. The  coitus  having  been  performed  with  a  woman 
whose  menses  had  begun,  there  is  a  blood-corpuscle  (I 
could  never  discover  blood-corpuscles  in  the  ejacula- 
tions of  so-called  continent  persons,  as  reported  by 
Richard *) ;  a  few  seminal  filaments  join  the  blood-cor- 

1  Histoire  de  la  generation.     Paris,  1883,  p.  159. 


74.  SEXUAL  IMPOTENCE. 

puscle,  but,  after  a  momentary  effort,  push  the  corpuscle 
aside. 

October  17. — Coitus  after  forty-eight  hours'  rest;  ex- 
amination eight  hours  later;  result,  about  fifty  dead  fila- 

liirllts. 

October  18. — Coitus  after  sixteen  hours'  rest;  exam- 
iimlion  sixteen  hours  later;  result,  many  spermatozoids 
had  died,  a  few  had  been  ejaculated  dead. 

On  the  same  day,  the  sperm  of  a  coitus,  being  the 
third  within  twenty-four  hours,  was  examined  ten  hours 
after  coition ;  result,  very  numerous  spermatozoids, 
movement  very  energetic  and  as  if  with  a  purpose  in 
view. 

October  20. — One  coition  after  an  interval  of  forty- 
eight  hours ;  examination  ten  hours  after ;  result,  fifty 
spermatozoids,  all  dead  but  a  few.  Second  coition,  one 
hour  after  first ;  examination  nine  hours  later ;  result, 
spermatozoids  very  numerous  and  exceedingly  lively ; 
scarcely  one-third  had  died. 

October  21. — Coition  after  an  interval  of  twenty-three 
hours  ;  examination  eight  hours  later ;  result,  numerous 
spermatozoids,  all  living. 

October  22. — Coition  after  sixteen  hours'  rest ;  exam- 
ination sixteen  hours  later  ;  result,  fewer  spermatozoids 
ejaculated  alive,  and,  with  few  exceptions,  all  had  died 
prior  to  my  examination. 

October  23. — Coition  after  thirty  hours'  rest ;  examina- 
tion seventeen  hours  later ;  result,  very  many  sperma- 
tozoids, but  nearly  all  had  died  ;  besides  a  few  ejaculated 
dead. 

Similar  results  from  examinations  of  sperm  from  same 
individual  on  October  24  and  25. 

October  28. — Coition  after  sixty-four  hours'  interval ; 


PHYSIOLOGY   OF  THE   SEXUAL  ACT.  75 

examination  eight  hours  later ;  result,  about  sixty  sper- 
matozoids,  which  had  nearly  all  died,  but  one-third  of 
them  had  been  ejaculated  dead. 

October  29. — Coition  after  six  hours'  rest ;  examination 
two  hours  later;  result,  very  numerous,  active  sper- 
matozoids,  only  a  few  ejaculated  dead  ;  very  few  had  died. 

October  31. — Coition  after  fifty-eight  hours'  interval ; 
examination  sixteen  hours  later;  result,  spermatozoids 
few  in  number,  nearly  all  ejaculated  dead ;  the  rest  had 
died. 

Xon'inbcr  /. — Coition  after  fifteen  hours'  rest;  exami- 
nation one  hour  later ;  result,  rather  more  spermatozoids, 
nearly  all  alive,  though  not  moving  with  energy  ;  others 
ejaculated  dead. 

On  same  day,  a  second  coition  after  fifteen  hours  ;  ex- 
amination ten  hours  later ;  result,  spermatozoids  numer- 
ous, lively,  only  a  few  ejaculated  dead. 

SECOND    SUBJECT    FOR    OBSERVATION. 

Powerful  man,  thirty  years  old,  healthy,  though  in- 
clined to  obesity  ;  enjoying  life,  very  vigorous  in  sexual 
matters,  and  observes  no  rule  at  all ;  offers  himself  for 
ten  days'  observation. 

February  10. — Coition  after  forty- one  hours'  interval ; 
examination  ten  hours  later ;  result,  spermatozoids  few 
in  number,  but  moving  with  energy  ;  few  ejaculated  dead, 
few  died  after  ejaculation. 

Same  day,  second  coition,  one  hour  later ;  examina- 
tion nine  hours  after ;  result,  spermatozoids  very  numer- 
ous, lively,  and  moving  energetically  ;  without  exception 
ejaculated  alive,  and  only  very  few  had  died. 

February  11. — Coition  after  twenty-three  hours'  rest ; 
examination  ten  hours  later ;  result,  spermatozoids  less 


76  SEXUAL   IMPOTENCE. 

numerous  ;  some  moving,  some  had  died,  the  rest  ejacu- 
lated dead. 

/•'rbniary  13. — Coition  after  an  interval  of  forty-three 
hours;  examination  fifteen  hours  later;  result,  sper- 
matozoids  very  few  and  most  of  them  ejaculated  dead  ; 
none  moving. 

February  1£. — Coition  after  thirty  hours'  rest;  ex- 
amination and  result,  same  as  February  13. 

February  15. — Coition  after  seventeen  hours1  rest ; 
examination  sixteen  hours  later;  resultx  spermatozoids 
numerous,  moving  energetically. 

Same  day,  second  coition  six  hours  later  ;  examination 
ten  hours  afterward  ;  result,  spermatozoids  not  very  nu- 
merous, but  movement  lively  ;  most  of  the  forms  young  ; 
none  were  ejaculated  dead. 

February  17. — Three  coitions  within  six  hours;  sper- 
matozoids of  the  third  coition  examined  ten  hours  after ; 
very  numerous,  some  of  them  still  moving  with  energy ; 
many  had  died,  only  few  were  ejaculated  dead. 

February  18. — Coition  after  eleven  hours,  therefore 
fourth  coitus  within  seventeen  hours ;  examination  one 
hour  after;  result,  spermatozoids  less  numerous,  but 
moving  with  great  activity  and  energy;  few  ejaculated 
dead,  almost  none  died  after  ejaculation. 

February  19. — Coition  after  fifteen  hours  ;  examination 
ten  hours  later ;  result,  spermatozoids  extraordinarily 
numerous,  very  well  developed,  with  energetic  and  lively 
motion ;  none  ejaculated  dead,  and  only  isolated  ones 
had  died. 

THIRD    SUBJECT    FOR    OBSERVATION. 

Age  not  quite  thirty,  healthy  and  vigorous,  life  very 
active,  but  finds  time  to  enjoy  it,  and  makes  best  use  of 
his  leisure  hours  for  venery. 


PHYSIOLOGY   OF  THE   SEXUAL   ACT.  77 

After  fifteen  days1  abstinence,  intercourse  fourteen 
times  within  six  days.  The  last  ejaculation  examined 
scarcely  one-quarter  hour  after ;  result,  spermatozoids 
very  numerous,  many  well  developed,  moving  with 
energy  and  vivacity.  The  field  of  vision  shows  the 
picture  that  Ultzmann  compared  to  an  ant-hill. 

From  these  observations  and  many  more  I  have  made, 
it  may  be  concluded  that,  with  persons  who  have  accus- 
tomed themselves  to  frequent  intercourse  and  have  the 
power  to  do  so,  the  number  of  spermatozoids  increases 
with  the  frequency  of  coition,  instead  of  decreasing,  as 
supposed  by  the  older  authors.  It  may  be  concluded 
also  that  the  spermatozoids  become  very  numerous,  well 
developed,  lively,  and  energetic  only  when  coition  is 
repeated. 

It  is  difficult  to  say  to  what  this  phenomenon  is  due, 
though  it  is  probable  that  the  sperm  of  the  vesiculae 
seminales,  which  is  poorer  in  spermatozoids,  is  evacuated 
first,  and  that  only  after  that,  by  the  repetition  of  coition, 
come  the  contents  of  the  vasa  deferentia,  and  last  of  all 
those  of  the  testicles.  This  circumstance  may  be  of 
special  importance  in  the  consideration  of  certain  cases 
of  sterility. 

Furthermore,  such  results  justify  the  supposition  that 
the  spermatozoids  which  enter  the  vesiculae  seminales 
for  storage  lose  their  vitality  in  that  canal  gradually. 
According  to  the  results  of  my  observations,  however, 
they  lose  it  rather  quickly.  I  am  still  further  confirmed 
in  this  belief  by  the  fact  that,  although  I  have  very  often 
had  the  chance  to  examine  the  semen  from  nocturnal 
emissions,  sometimes  within  an  hour  after  such  emis- 
sion, I  have  seldom  found  living  spermatozoids  in  such 
sperma.  Most  of  the  spermatozoids,  which  were  often 


78  SEXUAL  IMPOTENCE. 

found  in  groat  numbers,  looked  as  if  they  had  been  ejac- 
ulated dead,  while  only  few  had  the  appearance  of 
having  been  ejaculated  alive  and  of  having  died  on  ac- 
count of  their  low  vitality.  I  must  not  omit  the  observa- 
tion that  the  first  portion  of  a  pollution  scarcely  ever 
contained  a  living  spermatozoid,  whilst  the  second  was 
more  likely  to  show  living  forms. 

In  my  numerous  microscopic  examinations  of  sperm 
I  have  made  a  few  more  discoveries,  which  I  shall  here 
adduce  briefly.  The  energy  of  movement  of  a  sperma- 
tozoon is  most  easily  determined  by  gentle  pressure  on 
the  cover-glass,  which  causes  a  current  in  the  small 
quantity  of  seminal  fluid  between  the  two  glass  disks.  If 
there  are  any  spermatozoa  moving  with  energy,  they  will 
swim  unaffected  by  the  current,  and  continue  in  their 
original  direction,  some  swimming  against  the  current. 

The  forward  movement  of  the  spermatozoids  seems 
to  me  to  be  produced  not  by  a  whip-like  motion,  as  has 
been  stated,  but  rather  by  a  regular,  rudder-like  action 
on  the  part  of  the  tail.  This  action  is  seen  plainly  when 
a  dying  spermatozoon  is  watched  ;  the  movements  grow 
slower  and  slower  until  they  gradually  cease  altogether. 

It  is  very  interesting  to  watch  how  spermatozoa  often 
meet  with  premature  death.  A  spermatozoon  swim- 
ming along  quite  energetically  suddenly  strikes  some 
obstacle ;  the  tail  finds  itself  caught  between  masses  of 
detritus,  fragments  of  cells ;  the  spermatozoon  makes 
desperate  efforts,  moves  spasmodically,  and  seems  thus 
to  use  up  all  its  vital  power  in  a  short  time,  as  it  quickly 
dies.  Sometimes  the  spermatozoon  succeeds  in  disen- 
gaging itself,  but  usually  it  suffers  some  injury.  I  once 
saw  one  with  a  sharp  bend  in  the  tail  close  behind  the 
head  swim  on  in  a  lively  manner. 


CHAPTER  IV. 
ETIOLOGY   OF    IMPOTENCE. 

AMONG  the  circumstances  that  determine  sexual  vigor 
the  foremost  of  all  is  the  structure  of  the  genitals.  We 
shall  not  here  take  into  consideration  abnormal  forma- 
tions, as  they  will  be  treated  specially,  but  shall  limit 
our  attention  to  genitals  anatomically  normal. 

The  appearance  of  the  genitals  varies  considerably  as 
regards  size,  form,  and  color.  The  differences  are  notice- 
able even  in  childhood,  in  which  case  they  cannot  be 
ascribed  to  extraneous  causes.  Small  genitals  are  always 
a  sign  of  insignificant  sexual  power,  while  large  ones, 
remaining  in  proportional  size  during  erection,  indicate 
great  power.  There  are  genitals  which  during  sexual 
repose  show  large  dimensions,  but  which  are  flabby  and 
appear  large  only  in  consequence  of  the  extent  of  the  vas- 
cular meshes  of  the  cavernous  tissue,  and  do  not  grow 
larger  proportionally  by  the  filling  with  blood  during 
erection.  In  such  genitals  erections  do  not  occur  readily, 
and  they  accordingly  indicate  anything  but  sexual  vigor. 
Such  qualities  belong  to  genitals  which  owe  their  size  to 
sexual  excesses  committed  before  puberty. 

Together  with  the  necessary  dimensions  the  texture 
of  the  penis  must  possess  firmness.  The  testicle  must  be 
sufficiently  large,  firm,  and  insensible  to  slight  pressure. 

Besides  this,  the  vascularity  of  the  genitals  is  of  im- 
portance. A  pinky,  transparent  cutis  of  the  glans  and 

warmth  of  the  penis  indicate  that  a  sufficient  quantity 

79 


80  SKXUAL   IMPOTENCE. 

of  blood  is  present.  A  pale  glans  and  ;i  penis  that  feels 
cool  indicate  local  poverty  of  blood  as  well  as  sexual 
weakness. 

Finally,  the  excitability  <if  /In-  m/vr-r/K/.s-  that  spread  in 
the  glans  is  of  consequence  with  regard  to  the  qualities 
of  the  genitals.  Where  the  glans  is  entirely  covered  by 
the  prepuce  its  surface  is  very  sensitive.  Such  subjects 
answer  quickly  to  external  excitation,  but  are  seldom 
noted  for  their  power,  as  coition  lasts  too  short  a  time, 
and  they  are  inclined  to  what  is  called  irritable  weakness. 
If  the  glans  is  covered  by  the  prepuce  only  partially  or 
not  at  all,  its  epidermis  grows  harder  and  less  sensitive  ; 
external  excitation  affects  tardily ;  a  greater  amount  of 
irritation  is  required  to  complete  the  coitus,  and  the 
sexual  organs  themselves  become  more  inclined  to  insen- 
sibility, which  becomes  more  noticeable  in  riper  age, 
when  the  central  excitations  grow  fewer  by  degrees. 
Innate  as  well  as  acquired  advantages  or  defects  in  the 
formation  of  the  sexual  organs  influence  their  capability 
of  action  advantageously  or  otherwise. 

Stronger  pigmentation  in  the  sexual  organs  is  gener- 
ally accompanied  by  greater  capacity  in  venery,  which 
fact  is  seen  in  negroes,  who  are,  as  a  rule,  endowed  with 
large  genitals.  The  well-known  rule  that  brown-haired 
men  have  usually  more  sexual  power  than  light-haired 
ones  is  admissible  only  in  the  comparison  of  men  of  the 
same  race. 

The  bodily  structure  of  a  man  is  of  the  utmost  weight 
with  respect  to  his  sexual  capacity.  It  is  self-evident 
that  an  individual  who  is  in  every  respect  healthy  and 
vigorous  will  accomplish  more  in  sexualibus  than  one 
sickly  and  weakly.  Apparent  anomalies  are  not  waul- 
ing, and,  indeed,  we  see  often  enough  that  decrepit  and 


ETIOLOGY   OF   IMPOTENCE.  81 

cachectic  individuals  commit  considerable  excesses  in 
venery ;  but  in  the  long  run  the  weakling  and  the  sick 
man  will  suffer  more  or  less  disaster,  and  only  an  ener- 
getic metabolism  can  for  any  length  of  time  enable  one 
with  any  effect  to  resist  the  manifold  ravages  of  the  waste 
of  semen. 

Due  weight  must  here  be  allowed  also  for  hereditary 
predisposition.  There  are  families  in  which  all  the  male 
members  are  distinguished  for  great  sexual  power ; 
whereas  the  contrary  may  be  noticed  often  enough  in 
other  families.  I  can  only  agree  with  Morrow l  when  he 
says,  "  The  important  role  which  heredity  plays  in  deter- 
mining disorders  of  the  genital  function  has  not  been 
fully  recognized  nor  sufficiently  emphasized  by  writers 
upon  the  subject.'1  Indeed,  I  expressed  the  same  views 
years  ago.2  Idiosyncrasy,  in  fact,  all  the  psychical  quali- 
ties of  a  man,  powerfully  influence  his  sexual  capacity. 

Of  great  importance  also  is  the  age.  Some  authors 
allow  a  greater,  others  a  lesser,  latitude.  There  are 
severe  moralists  who  will  not  allow  sexual  enjoyment 
before  a  man  has  completed  his  twenty-fifth  year,  and 
who  say  that  he  must  be  moderate  even  then,  and  desist 
from  it  when  he  is  fifty  years  old. 

The  vast  difference  in  the  opinions  held  upon  this 
subject  evidently  proves  that  no  fixed  rule  can  be  laid 
down.  Most  authors  have  committed  the  error  of  al- 
lowing their  personal  experience  to  act  as  a  criterion. 


1  Functional  Disorders  of  the  Male  Sexual  Organs.     A  System 
of  Genito-Urinary  Diseases,  Syphilology,  and  Dermatology.     New 
York,  1893,  vol.  i.  p.  1001. 

2  Pathologie  und  Therapie  der  Mannlichen  Impotenz.      Wien 
und  Leipzig,  1889,  pp.  45,  73-83. 

6 


82  SEXUAL  IMPOTENCE. 

The  following  general  principles  may,  however,  be 
stated : 

Nature  alone  indicates  the  time  when  a  man  should 
satisfy  sexual  desire.  The  course  of  nature  should  in 
no  wise  be  interfered  with  or  anticipated.  When  nature 
has  done  her  work  of  bringing  the  man  to  maturity, 
when  the  testicles  have  produced  sperm,  and  that  sperm 
is  thrown  out  by  pollutions,  when  the  youth's  whole 
being  is  undergoing  a  radical  change,  then  I  cannot 
understand  why  he  should  not  satisfy  that  impetuous, 
irresistible  longing;  wrhy  he  should  be  condemned,  in 
the  best  part  of  his  life,  to  become  an  onanist  or  to  lose 
his  power  by  pollutions. 

Virility  generally  begins  when  the  man  reaches  the 
age  of  eighteen  years,  increasing  until  he  has  reached 
his  fortieth  year.  From  that  time  it  begins  slowly  but 
steadily  to  decrease,  until  in  his  sixty-fifth  year  it  is 
usually  extinguished.  There  are  some  who  in  their 
sixteenth  year,  and  even  before,  are  perfectly  fit  for 
coition,  and  a  great  many  who  preserve  their  sexual 
power  to  an  advanced  age  ;  whereas,  on  the  other  hand, 
some  hardly  enter  into  puberty  at  the  age  of  twenty- 
four,  and  are  overcome  by  senile  impotence  before  they 
are  fifty  years  old. 

Besides  these  congenital  qualities,  over  which  the  in- 
dividual has  no  control,  there  are  many  circumstances 
generally  beyond  his  control  also,  but  which  he  may, 
nevertheless,  endeavor  to  bring  about  so  as  to  influence 
his  virility  more  or  less. 

Here  we  must,  first  of  all,  mention  acquired  deformi- 
ties and  diseases  of  the  genitals  or  other  organs ;  after 
that  the  manner  in  which  one  husbands  the  gifts  of  na- 
ture. Too  much  indulgence  may  be  just  as  injurious 


ETIOLOGY   OF  IMPOTENCE.  83 

as  too  little.  Furthermore,  there  must  be  taken  into 
account  the  influence  of  nutrition,  of  certain  alimen- 
tary or  medicinal  substances,  and  of  occupation  and 
habits.  Finally,  there  are  many  other  things  that  have 
more  or  less  influence  on  the  strength  of  a  man  in 
sexual  matters,  and  their  connection  with  virility  seems 
peculiar  and  strange  because  we  cannot  understand 
it. 

The  varying  influence  of  seasons,  for  instance,  modifies 
the  sexual  power,  though  this  cannot  be  acknowl- 
edged unconditionally.  Everybody  knows  that  man  is 
given  to  love  in  spring  more  than  in  any  other  season. 
Some  French  investigators  (such  as  Villerme,  Quetelet, 
and  Smits)  have  worked  out  tables  in  which  the  order 
in  which  the  months  are  named  is  indicative  of  the 
number  of  conceptions  that  occurred  therein ;  but  they 
cannot  be  accepted  as  valid,  because  such  proofs,  based 
on  statistical  calculations,  are  not  always  independent  of 
chance.  Nor  can  we  accept  as  an  absolute  proof  the 
fact  that  most  crimes  against  morality  are  committed  in 
the  spring ;  as  here,  too,  many  other  social  conditions 
play  a  part  not  unimportant. 

Besides  the  influence  of  season,  we  must  bear  in 
mind  the  momentary  disposition  and  the  varying  feelings 
of  inclination  and  disinclination,  to  which  we  cannot  deny 
a  rather  strong  control  over  virility. 

After  this  brief  enumeration  of  the  most  important 
circumstances  capable  of  influencing  sexual  virility,  we 
may  pass  on  to  a  description  of  the  individual  forms  of 
impotence. 

A  classification  of  the  manifold  forms  of  this  disease, 
which  has  hitherto  received  so  little  attention,  offers,  for 
the  present,  insurmountable  difficulties. 


84  SEXUAL   IMPOTENCE. 

Krafft-Ebing's  schema1  of  all  the  sexual  neuroses  is 
very  ingenious.  He  distinguishes  three  kinds.  They 
are — 

I.  Peripheral  neuroses. 

1.  Sensory. 

a.  Anesthesia. 

b.  Hyperesthesia. 

c.  Neuralgia. 

2.  Secretory. 

a.  Aspermia. 
6.  Polyspermia. 

3.  Motor. 

«.  Pollutions  (spasm). 

6.  Spermatorrhea  (paralysis). 

II.  Spinal  neuroses. 

1.  Affections  of  the  erection  center. 

a.  Irritation. 
6.  Paralysis. 

c.  Inhibition. 

d.  Irritable  weakness. 

2.  Affections  of  the  ejaculation  center. 

a.  Abnormally  easy  ejaculation. 

b.  Abnormally  difficult  ejaculation. 

III.  Cerebral  neuroses. 

1.  Paradoxia. 

2.  Anesthesia. 

3.  Hyperesthesia. 

4.  Paresthesia. 

Ingenious  as  this  classification  is,  it  is  of  no  practical 
use  for  our  purpose. 


1  Psychopathia  sexualis.    Stuttgard,  1890,  p.  24. 


ETIOLOGY  OF  IMPOTENCE.  85 

Furthermore,  Eulenburg1  considers  that  differences 
between  "  peripheral  neuroses"  and  "  spinoferic  neuro- 
ses" of  the  genitals  can  hardly  be  determined  except  on 
paper.  This  is  certainly  neatly  expressed,  and  holds 
good  also  with  reference  to  Eulenburg's  division  of  the 
sexual  neuropathic  phenomena,  or  with  reference  to  any 
other  possible  or  impossible  division  :  they  all  look  well 
on  paper,  but,  in  reality,  chaos  reigns. 

There  are,  as  we  have  seen,  many  causes  that  may 
lead  to  impotence ;  and  although  it  is  always  reducible 
to  partial  or  complete  failure  of  erection,  yet  the  acces- 
sory circumstances  accompanying  this  main  moving  force 
are  often  various,  according  to  the  exciting  cause.  In 
consequence  of  this,  the  disease  may  present  to  a  careful 
investigator  very  different  aspects,  and  therefore  will 
demand  also  very  different  forms  of  treatment,  deter- 
minable  by  the  actual  causes. 

The  usual  division  of  impotentia  eoeundi  into  an  or- 
ganic form,  a  psychical  form,  a  form  depending  on  irri- 
table weakness,  and  a  paralytic  form  is  surely  not  suffi- 
cient, because  there  are  so  many  varieties  that  cannot 
be  forced  into  such  a  frame. 

Beard 2  distinguishes  the  following  forms  : 

1.  Slight  deficiency,  both  of  desire  and  capacity. 

2.  Deficiency  of  capacity  with  increase  of  desire. 

3.  Profound  deficiency  both  of  desire  and  capacity. 

4.  Erectile  power  increased  abnormally,  but  no  dis- 
charge of  seminal  fluid. 


1  Sexuelle  Xeuropathie.     Leipzig.  1895.  p.  44. 
-  Beard  and  Rockwell.  Sexual  Neurasthenia,  fifth  edition.     New 
York.  1898.  p.  124. 


86  SEXUAL  IMPOTENCE. 

Mantegazza1  distinguishes  even  as  many  as  ten  de- 
grees or  grades  of  sexual  capacity,  but  avoids  the  ex- 
ceedingly difficult  task  of  a  classification  of  the  different 
forms  of  impotence. 

1  Igiene  deH'amore.     Milano,  1881,  p.  112. 


CHAPTER  V. 

FORMS   OF  IMPOTENCE. 

CONGENITAL    MALFORMATIONS     AND     DEFECTS     OF     THE     SEXUAL 

ORGANS. 

CONGENITAL  malformations  of  single  organs  of  the 
human  body  are,  fortunately,  very  scarce.  While  in  the 
service  of  the  Croatian  government  I  had  to  examine  the 
conscripts.  Among  six  thousand  young  men  there  were 
only  five  who  showed  malformations  of  importance,  and 
in  three  only  were  the  genitals  affected. 

As  all  these  six  thousand  men  were,  without  excep- 
tion, over  twenty  years  of  age,  and  as  many  deformed 
individuals  do  not  attain  that  age,  it  would  not  be  safe 
to  infer  an  infrequency  of  malformations ;  but  we  might 
rather  conclude  from  it  the  frequency  of  malformation 
of  the  genitals,  because  it  does  not  shorten  life  so  fre- 
quently as  malformation  located  elsewhere. 

Hypospadia  and  excessive  smalmess  are  the  most  fre- 
quent of  the  malformations  connected  with  these  parts  ; 
while  entire  absence  of  these  organs  is  the  most  infre- 
quent. 

In  malformations  which  prevent  copulation  altogether, 
the  outer  attributes  of  virility  are  absent.  The  whole 
appearance  of  these  unfortunate  beings  resembles  that  of 
a  woman,  a*d  appearance,  voice,  and  behavior  indicate 
that  the  formation  of  the  genitals  is  not  normal. 

In  the  exceedingly  rare  cases  of  absence  of  the  penis 

87 


88  SEXUAL   IMPOTENCE. 

there  could  be  no  possibility  of  copulation.  Entire  ab- 
sence of  both  testicles  is  quite  as  rare,  and  has,  perhaps, 
never  been  observed  in  adults. 

Extreme  smallness  of  the  penis  alone,  or  of  the  penis 
and  testicles,  occurs  now  and  then,  and  is  noticeable 
either  at  birth  or  later  as  an  arrest  of  development.  If 
the  testicles  are  normally  developed,  and  only  the  penis 
has  remained  very  small,  the  desire  and  relative  capacity 
for  coition  may  be  preserved  unweakened,  but  the  result 
will  be  a  failure. 

Such  individuals  are  well  aware  of  their  defect,  and 
are  with  difficulty  induced  to  have  intercourse  with  the 
opposite  sex,  particularly  after  they  have  had  some  bitter 
experience.  Most  of  them  seek  to  satisfy  in  some  other 
way  the  sexual  desire  that  they  may  feel.  Few  of  these 
wretched  beings  are  fortunate  enough  to  meet  with  a 
woman  who  possesses  the  ability  to  suppress  her  sexual 
passions  sufficiently  to  enable  her  to  live  contentedly 
with  a  husband  so  deficient  in  the  sexual  organs,  although 
the  capacity  of  self-denial  is  a  peculiarity  inborn  with 
the  entire  sex.  If  both  penis  and  testicles  are  diminu- 
tive, there  is  a  poor  prospect  for  the  sexual  desire,  such 
subjects,  as  a  rule,  never  holding  intercourse  with  the 
other  sex. 

The  opposite  deformity — viz.,  excessive  development 
of  the  penis — occurs  also,  and  is  usually  indicative  of 
great  sexual  power.  It  offers  no  obstacle  to  coition, 
provided  a  proper  mate  is  found,  and,  generally,  little 
difficulty  is  experienced  in  this  line. 

The  negro  has  a  very  large  penis,  but  it  does  not  in- 
crease during  erection  in  proportion  to  its  size  when 
flaccid.  The  Japanese,  on  the  other  hand,  has  a  small 
penis,  even  in  proportion  to  his  small  stature. 


FORMS  OF  IMPOTENCE.  89 

It  is  very  rare  to  find  a  marked  congenital  flexion  in 
the  penis  arising  from  a  deformity  in  the  corpora  caver- 
nosa.  Curvature  to  a  very  considerable  degree  would 
render  copulation  impossible. 

Of  more  frequent  occurrence  is  a  defective  develop- 
ment of  the  erectile  tissue,  in  which  case  the  penis  may 
be  sufficiently  large,  but  abnormally  flabby.  This  con- 
genital defect  is,  in  my  eyes,  of  great  consequence,  and 
I  cannot  understand  how  it  is  that,  in  spite  of  its  fre- 
quency, it  is  ignored  entirely  by  modern  authors.  Lal- 
lemand  alone  has  carefully  described  this  condition. 

Impotence  is  said  sometimes  to  depend  also  on  great 
narrowness  of  the  oriflcium  externum  urethrae.1  The 
possibility  of  this  may  be  admitted  the  more  readily 
since  we  know  that  stricture  of  the  urethra  undoubtedly 
causes  impotence.  I  have  had  occasion  to  observe  a 
man  fifty-five  years  old  whose  orificium  externum  was 
exceedingly  narrow,  and  who,  though  virile,  could  never 
impregnate  a  woman.  It  is  more  than  probable  that 
this  malformation,  unimportant  as  it  may  seem,  was  the 
cause  of  the  sterility ;  for  the  semen  was  quite  normal, 
and  an  examination  of  his  wife  brought  no  explanation 
to  light. 

Some  consideration  is  also  due  to  the  state  of  the 
prepuce  and  the  frenulum.  Complete  absence  of  pre- 
puce probably  occurs  very  seldom.  Even  among  the 
Orientals  and  Hebrews,  who  have  continued  to  remove  it 
for  thousands  of  years,  this  artificially  caused  absence 
has  never  yet  become  hereditary.  Even  if  the  absence 
of  the  prepuce  were  an  effect  of  inheritance,  it  could 

1  Maximilian  v.  Zeissl,  Ueber  die  Impotenz  des  Mannes  und  ihre 
Behandlung.  Wiener  medicinische  Blatter.  Wien,  1885,  Nr.  15. 


90  SEXUAL  IMPOTENCE. 

never  be  prejudicial  to  the  capacity  for  coition.  I  '<  «- 
sibly,  as  Roubaud1  asserts,  the  glans  grows  there  from 
less  sensitive,  the  act  less  agreeable,  and  consequently 
the  carnal  appetite  less  keen. 

More  frequently  occurs  a  superfluity  of  prepuce, 
causing  phimosis.  Even  phimosis  in  the  highest  degree 
cannot  have  a  damaging  effect  on  the  capacity  for  copu- 
lation ;  it  can  only  interfere  with  the  natural  course,  and 
make  surgical  help  desirable.  I  must,  however,  call 
special  attention  to  the  fact  that  congenital  excessive 
length  of  the  prepuce  is  generally  accompanied  by  a  de- 
fective development  of  the  member  itself,  so  that,  in 
some  measure,  the  prepuce  is  only  too  long  for  the  ab- 
normally small  penis,  and  then  we  have  to  deal  only 
with  the  diminutive  size  of  the  penis.  Too  small  an 
aperture  through  the  prepuce  often  causes  sundry  dis- 
eases, especially  of  the  nerves.  In  recent  times,  obser- 
vations of  this  nature  grow  in  number.  In  cases  of 
congenital  phimosis  it  happens  now  and  then  that  the 
prepuce  adheres  to  the  glans  even  after  puberty  has 
been  reached,  and  this  would  be  a  positive  hindrance 
to  coition. 

In  California  I  had  an  opportunity  to  observe  a  case 
of  firmly  adherent  prepuce  occasioned  by  a  surgical 
operation  for  phimosis,  when  not  enough  of  the  prepuce 
had  been  removed,  and,  besides,  the  margin  of  the  wound 
had  not  been  stitched. 

The  frenulum  is  sometimes  too  long,  sometimes  too 
short.  In  the  latter  case  it  is  a  hindrance  to  erection. 
I  have  been  compelled  more  than  once  to  sever  a  frenu- 
lum that  was  too  short.  In  one  case  the  glans  was 

1  Traite  de  1'impuissance  et  de  la  sterilite.     Paris,  1876,  p.  100. 


FORMS  OF   IMPOTENCE.  91 

drawn  downward,  and  in  another  the  frenulum  tore 
during  coitus,  causing  great  pain. 

Not  infrequently  there  is  a  natural  inclination  toward 
fissures  on  the  surface  of  the  glans  and  the  inside  of  the 
prepuce,  whereby  a  temporary  difficulty  in  copulation 
may  be  occasioned.  I  have  seen  a  young  university 
professor  who,  after  every  excess  in  venery,  were  it  ever 
so  slight,  suffered  from  deep  and  gaping  fissures  on  the 
surface  of  the  glans. 

Hypospadia  of  a  high  degree — i.e.,  congenital  opening 
of  the  inferior  wall  of  the  urethra — and  the  much  rarer 
epispadia — i.e.,  congenital  opening  of  the  upper  wall  of 
the  urethra — may  cause  partial  or  absolute  impotence. 
Hypospadia  of  the  lowest  degree — viz.,  when  the  orifice 
of  the  urethra  is  situated  in  the  furrow  of  the  glans,  at 
the  root  of  the  frenulum — never  interferes  with  copula- 
tion, but  diminishes  the  chances  of  fecundation.  In  cases 
of  hypospadia  of  a  high  degree,  when  the  urethra  opens 
as  far  back  as  at  the  perineum,  and  the  member  itself  is 
very  small,  flattened,  and  bent  downward,  both  copula- 
tion and  fecundation  suffer,  as  a  matter  of  course. 

Quite  similar  are  the  cases  of  epispadia.  According 
to  the  degree  of  deformity,  the  member  is  at  the  same 
time  shortened,  flattened,  and  turned  upward  like  a 
hook,  so  that  introduction  into  the  vagina  succeeds  only 
partially  or  not  at  all,  and  the  injection  of  semen  is 
accomplished  with  great  difficulty.  Exceptionally,  im- 
pregnation may  result  in  cases  of  either  infirmity,  even 
when  of  a  high  degree.1 

Sundry   circumstances   may  disturb   the   process   of 

1  Hofmann,  Lehrbuch  der  gerichtlichen  Medicin.  Wien,  1881, 
II.  Aufl.,  p.  68. 


92  SEXUAL  IMPOTENCE. 

"  descensus  testiculorum,"  so  that  either  one  testicle 
remains  in  the  abdominal  cavity  or  else  both.  The 
former  case  is  called  monorchidia,  and  occurs  oftener 
than  the  latter,  which  is  called  cryptorchidia.  Neither 
of  these  conditions  causes  impotence  if  it  is  not  accom- 
panied by  defective  growth  of  the  testicles.  It  is  even 
asserted  that  such  hidden  testicles  produce  more  sperm 
because  they  are  in  a  warmer  location.1  Cryptorchidia 
is  said  to  cause  sterility,  but  not  impotence. 

These  two  assertions  are  contradictory.  Godard, 
Hunter,  and  Curling  have  in  cases  of  cryptorchidia  found 
no  spermatozoa  in  either  testicles  or  vasa  deferentia,  nor 
in  the  vesiculae  seminales.  Contrary  to  this,  Taylor2 
knows  four  cases  of  cryptorchidia  where  there  are  chil- 
dren;  Pelikan,  one  case ;  and  Beigel3  found  spermu  in 
the  semen  of  one  affected  with  cryptorcliidin. 

It  is  beyond  doubt  that  monorchidia  cannot  be  inju- 
rious to  potentia  coeundi  or  generandi,  because  it  seems, 
indeed,  to  be  hereditary.  I  myself  know  a  civil  official 
in  Europe,  a  monorchis  with  large  penis,  who  was  very 
vigorous  in  sexualibus  until  an  advanced  age,  and  late 
in  life  begat  two  boys,  the  younger  of  whom  is  also  a 
monorchis.  Each  son  has  likewise  a  very  large  penis, 
and  resembles  his  father  in  vigor  in  venery. 

Young  people  afflicted  with  such  defects  usually  be- 
come very  unhappy  the  moment  they  are  aware  of  their 
defect,  because  they  believe  they  will  have  to  renounce 
sexual  enjoyment.  In  many  places  the  popular  belief 


1  D.  Campbell  Black,  Human  Anatomy  and  Physiology,  Part 
VII.  p.  6. 

2  Hofmann,  op.  cit.,  pp.  59,  60. 
'•'  Virdiow's  Arcliiv,  Bd.  cviii.  p.  144. 


FORMS  OF   IMPOTENCE.  93 

accredits  such  monorchids  with  possessing  extraordinary 
power. 

As  rare  curiosa  we  have  to  call  attention  to  her- 
maphrodites, or  individuals  who,  by  vicious  conforma- 
tion of  the  genitals,  are  hindered  partially  or  entirely 
from  indulging  in  intercourse  ;  also  the  much  rarer  cases 
of  partial  or  entire  want  of  single  parts  of  the  apparatus 
serving  as  excretory  ducts  for  the  semen,  such  as  the 
vasa  deferentia,  ductus  ejaculatorii,  and  vesiculse  semi- 
nales.  The  rarest  cause  of  impotence  may  be  congenital 
azoospermia. 

ACQUIRED    DEFECTS    IN    THE    SEXUAL    ORGANS. 

We  mean  by  this  the  permanent  defects.  The  various 
diseases  of  the  sexual  organs  will  be  treated  later  on. 

The  entire  or  partial  loss  of  penis  or  testicles  will  be 
the  first  subject  of  discussion.  In  the  Orient  there  are 
even  nowadays  people  on  whom,  during  infancy,  a  most 
atrocious  act  has  been  perpetrated, — that  of  cutting 
away  the  entire  external  apparatus  of  generation.  Such 
perfect  auiiichs  bring  higher  prices  than  those  who  are 
deprived  only  of  their  testicles.  In  Russia  we  have  the 
Skopti,  who,  in  insane  fanaticism,  voluntarily  submit  to 
such  a  mutilation. 

Of  course,  copulation  is  out  of  the  question  in  a  case 
of  complete  absence  of  the  external  genitals  ;  it  is  like- 
wise impossible  in  the  absence  of  a  penis.  Neglected 
venereal  diseases  sometimes  destroy  a  part  of  the  virile 
member,  and  malignant  neoplasms  sometimes  make  its 
removal  a  necessity.  There  are,  besides,  unfortunate 
accidents  and  traumatic  influences  that  may  cause  loss 
of  the  penis.  This  is  really  a  very  pitiable  condition, 
because  the  sexual  appetite  is  left,  while  the  possibility 


94  SEXUAL  IMPOTENCE. 

of  satisfying  it  is  gone.  If,  however,  the  traumatic  action 
has  left  part  of  the  penis,  there  is  no  impotence  as  long 
as  the  stump  remains  erectile.  I  knew  a  -wealthy  trades- 
rnan  who  had  lost  nearly  the  whole  of  the  glans  in 
consequence  of  a  simple  ulcerous  disease  which  he  had 
unwisely  kept  secret  and  neglected.  After  the  wound 
was  healed  he  had  regular  intercourse  with  his  wife,  but 
always  took  a  long  time  to  accomplish  ejaculation.  His 
wife  complained  that  the  friction  of  the  skin  and  the 
cicatricial  tissue  caused  her  pain,  wherefore  she  had 
always  to  apply  a  sufficient  quantity  of  grease  before 
copulation.  The  cicatricial  tissue  was  not  firm  ;  in  the 
flaccid  condition  of  the  penis  it  was  very  yielding.  I 
never  saw  the  stump  during  erection. 

The  absence  of  testicles  may  be  due  to  various  causes. 
First  of  all,  they  may  have  been  removed  surgically,-— 
an  unjustifiable  operation,  still  practised  in  the  Orient, 
and  in  Rome  considered  "ad  majorem  dei  gloriam  ;" l 
they  may  have  required  removal  on  account  of  disease 
or  the  growth  of  some  tumor ;  or,  finally,  they  may  have 
become  completely  atrophied  from  some  cause  or  other, 
as.  for  instance,  through  syphilis,  epididymitis,  or  pressure 
by  a  large  hydrocele,  varicocele,  scrotal  hernia,  etc. 

If  the  testicles  are  lost  before  puberty,  both  sexual 
desire  and  capacity  for  sexual  gratification  are  impossi- 
ble ;  whilst  both  may  be  preserved  for  some  time,  pos- 
sibly for  a  long  time,  if  the  testicles  are  lost  after  puberty. 
Such  cases  as  are  recorded  where  women  have  amused 

1  Mantegazza,  Gli  amori  degli  nomini,  vol.  i.  p.  175,  says,  "  Man 
castrated  himself  and  emasculated  others,  driven  to  this  infamous 
mutilation  by  the  most  opposite  reasons, — the  desire  to  triumph 
over  human  weakness  and  aspire  to  heaven,  revenge,  jealousy, 
luxury." 


FORMS  OF  IMPOTENCE.  95 

themselves  with  castrated  men  *  refer  to  individuals  who 
had  been  emasculated  only  a  short  time,  or,  at  least, 
after  puberty. 

At  the  University  of  Vienna,  a  fellow-student  of  mine 
had  an  obstinate  epididymitis  caused  by  gonorrhea  that 
brought  on  conditions  in  consequence  of  which  one  of 
the  testicles  had  to  be  removed,  whereupon  the  other 
testicle  atrophied.  This  unfortunate  young  man  prac- 
tised copulation  for  some  years  after  this,  boasted  of  it, 
and  quite  ostentatiously  courted  the  ladies.  Gradually 
his  power  of  copulating  vanished,  and  after  three  years 
he  withdrew  from  the  society  of  women  altogether,  and 
grew  peevish  and  reserved,  until  one  day  he  disappeared 
and  was  never  after  heard  of.  This  case  has  left  a  vivid 
impression  on  my  memory,  and  illustrates  quite  charac- 
teristically the  influence  of  the  virile  power  on  the  whole 
being. 

Absence  of  one  testicle,  from  whatsoever  cause,  leaves 
virility  unaffected  if  the  other  testicle  continues  its  func- 
tions. The  Hottentots  are  said  to  amputate  the  left  tes- 
ticle of  their  youths  before  entrance  into  matrimony.2 

Hydrocele  and  inguinal  hernia,  if  of  a  high  degree, 
may  encroach  upon  the  integument  of  the  penis,  causing 
that  organ  to  disappear  from  view  completely,  thus  pro- 
ducing a  mechanical  impediment  to  copulation.  Tumors, 
by  reason  of  their  size,  form,  and  position,  may  unfit  the 
member  for  introduction  into  the  female  genitals. 

Injurious  influences  of  a  traumatic  nature,  more  rarely 


1  "  Sunt  quas  eunuchi  imhelles  ac  mollia  semper 

Oscula  delectent  et  desperatio  barbae 

Et  quod  abortive  non  est  opus." — JUVENAL. 

2  Mantegazza,  Gli  amori  degli  nomini,  vol.  i.  p.  175. 


96  SEXUAL   IMPOTKM  K. 

diseases — as,  for  instant •»•,  those  following  gonorrhea — 
may  produce  changes  in  the  corpora  cavernosa,  such  as 
local  obliteration  of  the  meshy  passages,  nodi,  and  wheals 
or  callosities.  Under  such  circumstances  the  meshes  will 
not  all  fill  equally  in  erection,  some  parts  remaining 
quite  soft,  whereby  the  member  takes  on  a  more  or  less 
bent  form,  and  will  thus  become  unable  to  penetrate 
into  the  vagina.  Curschmann '  mentions  a  pertinent  and 
interesting  case,  not  isolated  in  literature  :  A  robust  rail- 
way official,  twenty-six  years  old,  awakened  one  morn- 
ing with  a  violent  erection.  He  endeavored  to  bend 
the  penis  downward,  when  suddenly  it  gave  way,  caused 
great  pain,  and  sank  down.  There  was  profuse  bleeding 
underneath  the  skin  of  the  penis,  so  that  it  was  black 
and  blue  and  almost  as  large  as  a  fist  when  Curschmann 
saw  the  patient.  After  recovery  it  was  discovered  that  by 
the  violence  practised  the  right  corpus  cavernosum  had 
been  torn,  and,  in  consequence,  at  every  erection  the 
penis  was  bent  upward  and  to  the  right,  so  that  copula- 
tion became  mechanically  impossible. 

Small  fissures  in  the  corpora  cavernosa  may  be  caused 
by  violent  motion  during  coitus.  Such  a  case  I  had 
under  my  care  in  the  year  1887.  A  restaurant-keeper, 
forty-one  years  of  age,  wanted,  after  a  slight  excess  in 
Baccho,  to  do  homage  to  Venus  also.  Both  he  and  his 
wife  were  in  a  somewhat  exalted  mood,  and  probably 
proceeded  rather  impetuously.  The  husband  told  me 
that  the  erection  was  of  unusual  vigor,  and  just  before 
ejaculation  he  suddenly  felt  a  sharp  pain,  so  that  he  had 
to  discontinue  the  act.  The  erection  subsided  at  once, 


1  Impotenz,   Band    ix.  2 ;   Ziemssen,  Handbuch    der  speciellen 
Pathologie  und  Therapie,  p.  530. 


FORMS  OF  IMPOTENCE.  97 

but  the  appearance  of  the  member  was  such  that  he  was 
compelled  to  get  medical  advice.  When  I  saw  the  man, 
an  hour  after  the  occurrence,  the  penis  was  much  swollen, 
black  and  blue  all  over,  only  an  irregular  streak  on  the 
right-hand  side  having  its  usual  color.  I  ordered  cold 
applications  and  occasional  painting  with  iodin.  After 
ten  days  the  swelling  had  disappeared.  I  could  feel  a 
somewhat  hardened  spot  on  the  left  corpus  cavernosum, 
but  there  was  no  further  interference  with  erection  and 
copulation. 

Finally,  there  are  to  be  mentioned  the  so-called  penis- 
bones.  They  are  of  very  rare  occurrence,  and  may 
arise  through  the  ossification  of  single  parts  of  the  albu- 
ginea  of  the  corpora  cavernosa.  In  case  they  seize  upon 
larger  parts,  they  may  prevent  dilatation,  and  thus  anni- 
hilate erection  and  the  power  of  copulation. 

Persistent  changes  in  the  mucous  membrane  of  the 
urethra,  such  as  strictures,  frequently,  but  not  always, 
cause  impotence. 

CONSECUTIVE    IMPOTENCE. 

The  performance  of  coition  requires  all  the  power  of 
the  individual  and,  above  all,  a  normal  state  of  the  whole 
body.  The  most  various  diseases  can  affect  sexual  vigor 
and  even  destroy  it. 

Of  least  account  is  virility  in  acute  diseases  of  a  serious 
nature.  Sexual  desire  is  heightened  during  the  prodro- 
mal stage  of  most  of  the  acute  diseases  as  long  as  the 
approaching  fever,  which  may  be  quite  high,  is  only 
announcing  itself  by  an  incomprehensible  agitation  and 
general  uneasiness.  Such  patients  are  sometimes  car- 
ried along  violently  to  sexual  excesses.  I  have  often 
watched  this  condition.  Thus,  for  instance,  a  man, 

7 


98  SEXUAL  IMPOTENCE. 

twenty-six  years  of  age,  accomplished  coition,  contrary 
to  his  usual  habit,  three  times  in  the  night  before 
scarlet  fever  declared  itself,  as  he  ascribed  heaviness  in 
his  legs  and  a  state  of  excitement  to  unsatisfied  sexual 
desire. 

During  the  illness,  on  the  contrary,  the  sexual  appetite 
is  nil.  During  convalescence  every  other  desire  will 
make  its  appearance  before  this  one,  and  its  reawakening 
is  with  justice  greeted  as  the  sign  of  returning  strength. 
The  patient  requires  his  forces  for  other  purposes  during 
attacks  of  acute  diseases,  and  his  temporary  stagnation 
in  sexual  activity  is  a  wise  provision  of  nature  ;  it  would 
be  absolutely  wonderful  if,  unfortunately,  other  functions 
of  the  body,  and  principally  that  of  digestion,  were  not 
impaired  at  the  same  time. 

After  a  protracted,  severe,  and  exhausting  illness,  dur- 
ing which  the  reproduction  of  spermatozoids  diminishes 
or  may  be  altogether  arrested,1  impotence  sometimes 
lasts  a  long  time.  All  the  other  consequences  of  the  ill- 
ness may  be  overcome  before  this  sexual  weakness,  so 
that  there  may  be  a  danger  of  its  becoming  permanent. 
Diphtheritis,  which  is  sometimes  followed  by  protracted 
paralysis  and  muscular  atrophy,  causes  impotence  now 
and  then.2 

The  assertion  is  met  with  in  old  books,  and  has  been 
copied  into  modern  ones,  that  persons  affected  with 
phthisis  are  generally  apt  to  commit  sexual  excesses 
(phthisicus  salax).  I  most  emphatically  deny  this.  A 


1  Rosenthal,   Ueber  den    Einfluss  von  Nervenkrankheiten   auf 
Zeugung  und  Sterilitat.     Wiener  Klinik,  1880,  Heft  5,  p.  165. 

2  Hofmann.Lehrbuch  der  gerichtlichen  Medicin.  Wien  und  Leip- 
zig, 1881,  p.  66. 


FORMS  OF   IMPOTENCE.  99 

phthisic  person  may  have  acquired  the  habit  of  frequent 
sexual  intercourse  in  former  times,  and  then,  during  his 
illness  also,  may  go  to  excess  for  a  time ;  but,  surely, 
these  are  exceptions.  As  a  rule,  phthisics  are  not  much 
inclined  to  physical  love,  and  this  is  in  keeping  with 
the  condition  of  their  physical  strength.  For  the  pur- 
pose of  noting  this  feature  I  have  for  many  years  past 
carefully  watched  and  examined  numerous  phthisical 
patients.  Without  exception  and  without  regard  to  age, 
they  all  entirely  renounce  sexual  gratifications  without 
experiencing  the  least  difficulty.  Indeed,  quite  young- 
husbands  affected  with  phthisis  practise  copulation  very 
infrequently  even  during  the  intermissions  of  their  ill- 
ness. 

Chronic  diseases  impair  the  sexual  power  proportion- 
ately to  their  effect  on  the  rest  of  the  body.  Chronic 
diseases  in  the  organs  of  respiration  and  of  digestion 
affect  virility  only  in  the  same  measure  as  they  debilitate 
the  body  in  general  and  lower  vitality.  Disease  of  the 
heart  does  not  impair  virility  until  it  amounts  to  a 
serious  disturbance  of  the  circulation.  In  the  first  stage  of 
the  disease  the  patient  is  rather  nervous  and  inclined  to 
sexual  excess.  The  same  is  true  with  those  suffering 
from  disease  of  the  liver. 

Virility  is  affected  also  by  some  general  diseases.  Im- 
potence is  particularly  frequent  with  persons  suffering 
.from  diabetes,  and  often  constitutes  one  of  the  first 
symptoms  of  the  disease,  noticed  long  before  the  physical 
being  commences  to  deteriorate.  The  seminal  secretion 
is  also  said  to  stop  in  this  disease. 

As  a  special  enemy  of  the  virile  power  must  be  men- 
tioned obesity,  which  has  only  recently  been  studied 
carefully  as  a  disease.  In  exceptional  cases  obese  people 


100  SEXUAL   IMPOTKNTK. 

may  be  very  powerful  in  sexualibus.  1  myself  have 
known  such  cases,  but  obese  persons  are  usually  loud 
of  their  comfort,  in  copulation  as  in  everything  else. 
They  frequently  prefer  the  pleasures  of  the  table  to 
those  of  love,  and,  moreover,  are  not  much  troubled  by 
sexual  desire.  They  give  off  but  a  scanty  secretion  of 
sperm,  often  suffer  from  adipose  degeneration  of  the 
testicles,  and  are  apt  to  become  completely  impotent. 
Kisch  found  invariably  that  the  sperm  of  nine  out  of 
ten  obese  men  showed  under  the  microscope  only  mo- 
lecular detritus  and  sperm-crystals,  but  no  spermatozoa 
at  all.  In  case  of  obesity  of  a  high  degree,  especially 
when  there  is  a  pcndnlniiK  afxlo'incn.  copulation  may  be 
mechanically  impossible. 

Anemia  may  be  a  cause  of  impotence,  like  any  other 
disease  carrying  in  its  train  debilitation  of  the  body  in 
general.  If  anemia  is  acute,  it  is  generally  accompanied 
by  impotence,  whilst  anemia  of  a  chronic  nature  causes 
at  first  only  weakening  of  the  sexual  capacity.  Accord- 
ing to  Roubaud,1  chlorosis  is  also  a  cause  of  impotence, 
but  the  case  he  describes  is  such  that  I  should  certainly 
characterize  it  as  neurasthenic. 

It  would  seem  almost  incredible  that  a  severe  cold 
could  affect  virility  seriously,  if  the  fact  were  left  out 
of  consideration  that  the  sense  of  smell  influences  the 
sexual  appetite.  In  a  man  really  vigorous  sexually  a 
cold,  be  it  ever  so  severe,  cannot  annihilate  virility, 
though  it  lessens  the  sexual  desire.  Schiff  has  removed 
the  nervi  olfactorii  in  new-born  dogs,  after  which  the 
male  was  unable  to  find  the  female.  Mantegazza  de- 
prived rabbits  of  both  eyes  without  any  effect  on  copu- 

1  Op.  cit.,  p.  213. 


FORMS  OF   IMPOTENCE.  101 

lation.1  In  man  the  olfactory  sense  has  not  so  great  a 
power  as  in  animals,  because  a  great  share  of  influence 
over  the  center  of  erection  has  been  allotted  to  other 
senses  as  well  as  to  the  developed  faculty  of  thinking ; 
nevertheless,  the  sense  of  smell  is  very  important. 

Impotence  is  very  frequently  a  symptom  of  disease  of 
the  central  or  peripheral  nerve  apparatus.  This  is  clear 
to  any  one  even  without  a  thorough  knowledge  of  phys- 
iology. The  practitioner  sees  typical  examples  almost 
every  day.  Nearly  all  diseases  of  the  brain  and  of  the 
spinal  cord  have  great  influence  over  the  virile  power, — 
some  only  for  a  time,  others  permanently,  according 
to  the  character  of  the  disease  in  question.  Some  of 
these  diseases  cause  at  first  increased  sexual  excitement, 
which,  in  the  further  course  of  the  disease,  is  followed 
by  diminished  sexual  power  or  absolute  impotence.  A 
given  disease  of  the  brain  and  spinal  cord  does  not 
always  have  the  same  effect  in  this  respect.  Apoplexy 
of  the  brain,  for  instance,  may  cause  frequent  erections 
at  one  time  and  entire  loss  of  sexual  desire  and  power 
at  another. 

In  the  first  stage  of  tabes  dorsalis  the  patient  expe- 
riences for  the  most  part  an  increased  sexual  desire, 
in  consequence  of  irritation  of  the  nerve-fibers  which 
innervate  the  sexual  apparatus ;  but  later  on  sexual 
vigor  gradually  diminishes  until  it  is  entirely  extinguished. 
Cases  are  known,  nevertheless,  where  tabes  existed  in  a 
high  degree  and  yet  the  patient  was  still  in  some  measure 
virile. 

From  this  little  we  may  conclude  that  there  are  no 
absolute  rules  to  be  given  about  the  state  of  virility 

1  Igiene  dell'amore.     Milano,  1881,  p.  277. 


LIBRARY 

VWVEIUUTV  OF  CALIFORNIA 


102  SKXl'AL  IMPOTENCE, 

in  affections  of  the  brain  and  spinal  cord.  The  physi- 
ri.ni  has  to  examine  every  individual  case  and  determine 
his  treatment  accordingly.  In  these  diseases  the  medical 
man  has  to  direct  his  attention  to  other  things ;  he  has 
no  time  to  think  of  sexual  virility,  especially  when  lil'r  is 
in  danger ;  and,  besides,  the  patients — as  the  ataxic,  for 
instance — care  very  little  for  the  sexual  power,  for,  as  a 
rule,  the  desires  are  silent. 

Impotence  seems  to  me  still  more  insignificant  in  some 
forms  of  i a. van  it u,  excepting  those  of  perverse  sexual 
sensation,  of  which  we  shall  speak  hereafter. 

Lesions  of  the  brain  or  spinal  cord  may  affect  virility 
according  to  the  spot  injured.  In  the  literature  of  the 
subject  we  read  of  cases  where  injury  of  the  cerebellum 
has  brought  about  a  loss  of  sexual  power.  In  cer- 
tain injuries  of  the  spinal  cord,  principally  those  of  the 
inferior  parts,  and  especially  in  spinal  concussion,  pria- 
pismus  has  been  noticed.  It  constitutes  one  of  the 
most  troublesome  symptoms,  and  defies  all  remedies. 
Lallemand  !  reports  a  very  characteristic  case.  Rosen- 
thai  2  mentions  a  case  he  has  observed  in  which  there 
was  a  fracture  of  the  fourth,  fifth,  and  sixth  cervical  ver- 
tebrae, with  paralysis  and  anesthesia  of  the  legs  and 
trunk,  together  with  retention  of  the  urine  and  feces, 
and  priapism  for  seven  days  during  life  and  thirty-six 
hours  after  death. 

Those  cases  in  which  impotence  is  to  be  considered 
as  a  symptom  of  some  disease  of  the  entire  nervous 
apparatus  have  more  importance  for  us,  because  they 


1  Des  pertes  seminales,  tome  ii.  lre  partie,  p.  64. 

2  Ueber  den  Einfluss  von  Nervenkrankheiten  auf  Zeugung  und 
Sterilitat.    Wiener  Klinik,  1880,  Heft  5,  p.  145. 


FORMS  OF   IMPOTENCE.  103 

occur  more  frequently,  are  of  more  consequence  to 
the  patient,  and,  finally,  because  therapeutic  action  is 
attended  with  more  chance  of  successful  result.  In 
these  cases  no  change  in  the  nerve  substance  can  be 
seen  either  macroscopically  or  microscopically.  The 
pathological  change  consists  simply  in  the  altered  capa- 
city of  nerve-action. 

In  the  first  place  must  be  mentioned  general  nervous- 
ness, or,  to  call  it  by  the  name  that  originated  in  America, 
neurasthenia,  or,  as  Rosenthal !  calls  it,  depressive  spinal 
irritation,  all  of  which  names  are  entirely  appropriate. 
Neurasthenia  has  grown  into  a  fashionable  disease  in 
this  age  of  electricity,  when  every  one  belonging  to  the 
upper  class  has  to  hurry  from  early  morning  till  late  at 
night  in  order  to  accomplish  his  measure  of  work  or  of 
pleasure  ;  when  the  everlasting  hurrying  begins  in  in- 
fancy and  still  continues  during  old  age.  By  these 
psychical  excitations,  which  exert  such  a  frequent  and 
lasting  effect,  the  center  of  the  vaso-constrictors  partic- 
ularly is  kept  in  a  state  of  irritation.  Beard  describes 
the  conditions  very  forcibly  when  he  says, — 2 

"  The  Indian  squaw,  sitting  in  front  of  her  wigwam, 
keeps  almost  all  of  her  force  in  reserve.  The  slow  and 
easy  drudgery  of  savage  domestic  life  in  the  open  air — 
unblessed  and  uncursed  by  the  exhausting  sentiment  of 
love,  without  reading  or  writing  or  calculating,  without 
past  or  future,  and  only  a  dull  present — never  calls  for 
the  full  quota  of  her  available  force ;  the  larger  part  is 
always  resting  on  its  arms.  The  sensitive  white  woman 


1  Op.  cit.,  p.  142. 

-  Beard-Rockwell,    Sexual    Neurasthenia,   fifth    edition.     New 
York,  1898,  p.  59. 


104  SEXUAL   IMPOTENCE. 

— pre-eminently  the  American  woman,  with  small  in- 
herited endowment  of  force,  living  in- doors,  torn  and 
crossed  by  happy  or  unhappy  love,  subsisting  on  fiction, 
journals,  receptions,  waylaid  at  all  hours  by  the  cruellest 
of  robbers,  worry  and  ambition,  that  seize  the  last  unit 
of  her  force — can  never  hold  a  powerful  reserve,  but 
must  live,  and  does  live,  in  a  physical  sense,  from  hand 
to  mouth,  giving  out  quite  as  fast  as  she  takes  in,  much 
faster  oftentimes,  and  needing  long  periods  of  rest  before 
and  after  any  important  campaign,  and  yet  living  as  long 
as  her  Indian  sister — much  longer,  it  may  be — and  bear- 
ing age  far  better,  and  carrying  the  affections  and  the 
feelings  of  youth  into  the  decline  of  life." 

Neurasthenia  is  either  congenital  or  acquired.  Ac- 
cording to  the  rules  of  heredity,  neurasthenic  parents 
have  neurasthenic  children,  or,  rather,  they  have  children 
naturally  inclined  to  neurasthenia,  which  will  tend  to  de- 
velop in  them  more  and  more  under  the  least  favorable 
circumstances,  and  who,  if  their  regimen  is  not  strictly 
regulated,  will  exceed  their  parents  in  neurasthenia. 

General  nervousness  with  its  manifold  symptoms  is 
by  no  means  a  rare  disease.  The  symptoms  are  fre- 
quently held  to  be  special  diseases,  and  it  is  only  an 
apparent  extreme  if  Beard  and  his  disciples  trace  most 
of  the  diseases  back  to  neurasthenia.  It  is  an  established 
fact  that  this  neurasthenia  is  of  much  more  frequent  oc- 
currence in  America  than  in  Europe.  Explanation  of 
this  circumstance  suggests  itself  when  we  compare  the 
mode  of  living  on  the  two  sides  of  the  Atlantic. 

Beard l  gives  the  following  definition  of  neurasthenia  : 
"  Neurasthenia  is  a  chronic,  functional  disease  of  the 

1  Beard -Rock  well,  op.  cit.,  p.  8(5. 


FORMS  OF   IMPOTENCE.  105 

nervous  system,  the  basis  of  which  is  impoverishment 
of  nervous  force,  deficiency  of  reserve,  with  liability  to 
quick  exhaustion,  and  a  necessity  for  frequent  supplies 
of  force ;  hence  the  lack  of  inhibitory  or  controlling 
powers,  physical  and  mental, — the  feebleness  and  insta- 
bility of  nerve  action  and  the  excessive  sensitiveness  and 
irritability,  local  and  general,  and  the  vast  variety  of 
symptoms,  direct  and  reflex." 

According  to  Arndt,1  neurasthenia  is  increased  or  de- 
creased excitability  and  irritability  in  conjunction  with 
incapacity  to  resist  external  influence, — i.e.,  weakness  in 
general. 

The  symptoms  of  neurasthenia  are,  according  to 
Beard,  the  consequence  of  reflex  irritations  which  pass 
not  merely  through  the  ordinary  sensory  and  motory 
nerves,  but  also  through  the  sympathetic  system  and  the 
vasomotor  nerves.  The  reflex  irritation  can  start  from 
any  part  of  the  body  and  pass  over  to  another,  but  the 
brain  and  the  digestive  and  reproductive  systems  are  to  be 
considered  as  the  main  seats.  The  symptoms  of  neuras- 
thenia are  inconstant  and  surprisingly  interchangeable. 
Erb  distinguishes  between  a  "  cerebral,"  a  "  spinal,"  and 
a  "  universal"  neurasthenia ;  Beard  recognizes,  moreover, 
a  "  sexual"  neurasthenia. 

According  to  Beard,  the  sexual  nervous  exhaustion 
may  be  considered  as  cause,  effect,  or  accessory  to  the 
other  kinds  of  neurasthenia,  but  must,  nevertheless, 
when  fully  developed,  be  distinguished  from  them  just 
the  same  as  general  neurasthenia  is  to  be  distinguished 
from  hysteria,  hypochondria,  and  the  various  organic 
diseases  of  the  nervous  system  with  which  it  was  con- 

1  Die  Neurasthenic.     Wien  und  Leipzig,  1885,  p.  40. 


106  SEXUAL   IMI'OTKM'K. 

fusingly  mingled  until  quite  recently.  Beard  considers 
si-xiial  neurasthenia  in  general,  and  particularly  in  refer- 
ence to  its  various  complications,  almost  the  most  im- 
portant of  all  the  forms  of  neurasthenia.  It  must  attract 
our  notice  that  he  further  asserts  that  the  clinically  con- 
nected local  conditions  of  sexual  weakness  in  man,  such 
as  impotence,  spermatorrhea,  and  the  "  irritable  pros- 
tata,11  are  to  be  looked  upon  merely  as  symptoms  of 
sexual  neurasthenia.  This  would,  indeed,  make  mat- 
ters easy,  and  the  single  word  "  neurasthenia"  would 
explain  many  a  thing  that  has  appeared  quite  inex- 
plicable until  now.  We  might,  however,  at  best,  con- 
sider as  symptoms  of  an  existing  sexual  neurasthenia 
only  those  cases  of  impotence  and  spermatorrhea  in 
which  the  organic  conditions  and  their  pathological 
alterations  offer  no  hold  at  all  for  an  explanation  of  the 
disease. 

Beard  states  that  the  causes  of  sexual  neurasthenia 
are:  unfavorable  social  conditions,  sexual  excesses,  im- 
moderate use  of  alcohol  and  tobacco,  special  irritants, 
grief,  and  even  climate ;  but,  above  all,  he  believes  that 
the  most  prominent  'and  predisposing  causal  force  is 
modern  civilization  in  regard  to  its  wants  and  claims 
that  are  increasing  from  day  to  day. 

The  attentive  reader  of  the  excellent  work  of  Lalle- 
mand  "  On  Spermatorrhoea11  will  not  fail  to  notice  that 
it  contains  a  similar  idea,  and  I  am  inclined  to  agree 
with  Lallemand  rather  than  with  Beard.  Lallemand 
quotes  observations  where  nearly  incurable  cases  of 
spermatorrhea  or  impotence  have  followed  insignificant 
causes — as,  for  instance,  slight  sexual  excesses — which 
would  have  had  in  other  individuals  either  no  effect  at 
all  or,  at  least,  an  effect  of  no  consequence.  Lallemand 


FORMS  OF   IMPOTENCE.  107 

explains  this  by  assuming  a  natural  nervous  predisposi- 
tion to  what  is  now  called  neurasthenia. 

Beard  asserts  that  neurasthenic  individuals  are  able  to 
accomplish  fatiguing  mental  work  for  years,  and  often 
during  the  whole  period  of  life ;  so  that,  sometimes, 
nervousness  and  neurasthenia  are  associated  with  an 
enormous  capacity  for  mental  exertion.  To  illustrate 
this  assertion,  Beard  says  that  it  was  by  neurasthenic 
authors  that  the  epoch-making  works  were  produced ; 
and  names  like  George  Eliot,  Darwin,  Heine,  Spencer, 
Edwards.  Kant,  Bacon,  Montaigne,  Joubert,  Rousseau, 
Schiller,  and  many  more  of  the  same  rank  illustrate 
beautifully  the  truth  of  the  sentence  that  it  is  possible 
to  produce  works  of  genius  and  of  consequence  even 
with  a  limited  quantity  of  nerve-substance  and  nerve- 
power,  attended  by  a  rapid  consumption  of  the  same. 
It  seems  to  me  fair,  however,  to  question  whether  all 
the  above-named  celebrities  were  really  neurasthenic, 
and  also  whether  their  neurasthenia  was  not  more  likely 
to  have  been  caused  by  their  colossal  mental  efforts 
than  to  have  produced  such  works. 

Beard's  method  of  reducing  to  neurasthenia  nearly  all 
the  pathological  states  in  the  system  of  reproduction 
would  at  once  rid  us  of  a  great  number  of  difficulties 
that  assail  every  one  who  studies  impotence.  It  would 
do  away  with  the  difficulty  of  arranging  the  different 
forms  of  impotency  according  to  some  logical  system  ; 
because  we  should  have  only  to  differentiate  a  neuras- 
thenic from  an  organic  impotence,  and,  moreover,  the 
diagnosis  would  also  be  an  easier  task  ;  but.  alas !  the 
facts  oppose  such  a  simplification,  and  we  have  nothing 
to  do  but  to  continue  the  old  patchwork  now  in  use 
as  well  as  we  can.  We  can  agree  to  the  consideration 


I  OX  SKXUAL    IMl'OTKXCK. 

nl'  neurasthenic  sexual  weakness  as  a  phase  of  a  spinal 
or  general  neiirastlieni;i.  and  must  look  upon  an  in- 
dependent or  self-subsisting  neurasthenia  sexualis  as  a 
form  of  impotence  occurring  frequently  enough. 

Very  often  virility  is  affected  by  diseases  of  the  sexual 
organs ;  but  let  it  be  stated  from  the  very  beginning 
that  this  influence  is  in  most  cases  a  secondary  one. 
Especially  diseases  of  the  colliculus  seminalis  and  of  the 
canals  and  apertures  discharging  into  it  cause,  as  a  first 
effect,  irregular  involuntary  losses  of  semen,  and  in  this 
manner,  indirectly,  slowly,  but  surely,  exhaust  the  sexual 
power. 

Several  diseases  of  the  sexual  organs  have  a  direct 
influence  on  virility.  Thus,  iron  ml*  <m<1  /'/Wr.s>  of  the 
penis  are  a  direct  obstacle  to  the  accomplishment  of 
coitus,  whether  they  are  of  a  specific  nature  or  not.  The 
same  may  be  said  of  the  condylomatous  proliferations  of 
a  high  degree,  because  every  erection,  and  still  more, 
friction  against  the  female  pudendum,  causes  great  pain. 

Some  individuals  suffer  much  from  nearly  continuous 
formations  of  herpes  on  the  prepuce,  the  vesicles  of 
which  afterward  turn  into  little  sores.  Uncleanliness  is 
not  always  the  cause  of  this  disease  ;  it  is  sometimes  the 
consequence  of  an  ulcus  molle.  Some  people  suffer 
from  it  without  any  apparent  cause  after  every  sexual 
connection,  such  vesicles  forming  on  the  member  and 
preventing  coition  for  a  time.  The  very  rare  preputial 
calculus  ("  calculs  du  prepuce,1'  Roubaud)  may  also 
form  an  obstacle  to  coition,  but  this  is  removable,  and  it 
certainly  occurs  only  in  consequence  of  great  unclean- 
liness  in  connection  with  phimosis.  Let  me  mention 
here  that  there  are  people  who,  seized  by  violent  sensual 
desires,  are  capable  of  bearing  even  great  pain ;  they 


FORMS  OF   IMPOTENCE.  109 

feel  no  scruple  in  satisfying  such  imperious  instincts, 
although  thereby  they  harm  themselves  as  well  as  others 
by  increasing  their  own  suffering  and  propagating  infec- 
tious diseases. 

Gonorrhea  also  is  in  reality  an  obstacle  to  copulation  ; 
but  it  is  an  obstacle  about  which  people  of  the  above 
description  care  very  little.  The  disregard  of  this  ob- 
stacle is  of  so  much  greater  frequency  as,  unfortunately, 
the  sexual  impulse  is  so  much  stronger  during  blennor- 
rhea,  particularly  in  its  acute  stage.  This  circumstance 
contributes  greatly  to  the  dissemination  of  the  disease. 
In  the  chronic  forms  of  gonorrhea  the  state  of  irrita- 
bility of  the  urethra,  and  therefore  of  the  whole  sexual 
apparatus,  exists  only  slightly  or  not  at  all,  but  is  some- 
times roused  to  unusually  violent  manifestations  by  the 
locally  applied  remedies,  such  as  caustic  injections,  etc. 

Other  obstacles  set  up  by  gonorrhea  to  the  accom- 
plishment of  copulation  are  the  further  complications 
and  the  higher  degrees  of  development  which  the  dis- 
ease often  produces,  and  the  extension  of  the  blennorrheic 
process,  such  as  inflammation  of  the  prostata,  the  vas 
deferens,  the  epididymis,  and,  more  rarely,  the  vesicula 
seminalis.  Any  one  afflicted  with  such  a  disease  will, 
however,  not  readily  yield  to  the  temptation  of  coition. 

Virility  is  affected  differently  by  the  many  diseases 
of  the  prostata,1 — viz.,  acute  and  chronic  inflammation, 
prostatorrhea,  tuberculosis,  abscesses  and  ulcers,  hyper- 
trophy and  atrophy,  cancer,  tubercles,  cysts,  concretions, 
calculi,  etc. 

The  question  has  been  asked,  Is  the  prostata  after  all 

1  Thompson,  Diseases  of  the  Prostata.  German  edition.  Erlangen, 
1867,  p.  40. 


110  SEXUAt    I.MI'OTFACK. 

of  special  importance  in  generation?  "I  would  draw 
attention  to  Mr.  Ellis's  important  paper  •  On  the  .Mus- 
cular Arrangements  of  the  Genito-Urinary  Apparatus,' 
wherein  is  remarked,  '  I  would  propose  the  name  orbic- 
ularis  vel  sphincter  u ret  line  for  both  the  prostata  and 
the  prolongation  around  the  membranous  urethra,  while 
I  would  confine  the  old  term,  prostate  (without  the 
word  gland),  to  the  thickened  and  more  powerful  part 
near  the  neck  of  the  bladder,'  " l 

Of  the  diseases  of  the  prostate  only  acute  inflammation 
and  atrophy  cause  temporary  or  permanent  impotency. 
whilst  chronic  inflammation  for  the  most  part  diminishes 
sexual  inclination  considerably.  The  other  diseases  of 
the  prostata  have  not  been  studied  much  in  their  influ- 
ence on  virility,  as  they  generally  make  their  appearance 
at  an  age  when  virility  is  of  but  small  consideration. 

Diseases  of  the  urimn-i/  bladder  are  apt  to  increase 
sexual  desire  temporarily,  catarrh  of  the  bladder,  for  in- 
stance, being  frequently  followed  by  greatly  increased 
libido  sexualis,  which  degenerates  now  and  then  into 
priapismus  and  satyriasis.  This  increase  in  sexual  desire 
is  still  more  frequently  met  with  when  the  neck  of  the 
bladder  alone  is  diseased,  and  in  such  cases  the  ejacu- 
lation is,  as  a  rule,  accompanied  with  pain.  Urinary 
calculi  also  nearly  always  cause  increased  irritability  in 
the  sexual  organs,  Roubaud 2  says  that  the  very  rare 
prolapse  of  the  urinal  bladder  through  the  inguinal 
canal  causes  impotence,  principally  through  the  retraction 
of  the  penis  occasioned  thereby. 


1  R.  Harrison,  On  some  Points  in  the  Surgery  of  the  Urinary 
Organs.    The  Medical  Record,  1888,  No.  3. 
sOp.  i-it..  p.  iVi'i. 


FORMS  OF   IMPOTENCE.  HI 

Strictures  of  the  urethra  have  different  effects  on  virility. 
They  very  often  cause  impotence,  and  are,  moreover, 
always  a  hindrance  to  fecundation. 

Superexcitation  from  disease  of  the  sexual  organs  is 
generally  followed  by  relaxation.  The  patient  who  suffers 
from  gonorrhea  is  sexually  excited ;  he  could  perform 
coition  oftener  than  in  the  state  of  health  if  he  were  not 
withheld  by  the  great  suffering  and  the  fear  of  the  con- 
sequences ;  but  when  this  state  of  irritation  is  past, 
reaction  will  set  in.  The  unusual  continence  to  which 
vigorous  young  men  are  forced  by  gonorrhea  neutralizes 
the  injurious  influence  of  over-excitement  of  the  nerves, 
and,  possibly,  of  the  specific  action  of  the  virus  of  gonor- 
rhea on  the  sexual  nerves.  Sometimes  we  see,  as  Ultz- 
mann  l  says,  that  such  patients  who  have  formerly  been 
virile  in  a  high  degree  become  temporarily  impotent  after 
an  attack  of  gonorrhea,  especially  when  the  disease  is 
accompanied  by  catarrh  of  the  bladder,  prostatitis,  or  or- 
chitis.  Ultzmann  thinks  that  in  such  cases  gonorrhea 
has  had  a  paralyzing  effect  on  the  nervous  apparatus 
of  the  prostata.  This  conjecture  must  be  admitted  as 
perfectly  well  founded,  but  it  does  not  exclude  the  possi- 
bility that  the  sexual  nerves  have  become  temporarily 
neurasthenic  in  consequence  of  the  strain  of  the  almost 
continuous  state  of  excitement. 

The  invention  of  the  endoscope  has  helped  us  to  a 
knowledge  of  a  number  of  diseases  of  the  mucous  mem- 
brane of  the  urethra,  among  which  the  affections  of  the 
colliculus  seminalis  and  of  its  adjoining  parts  interest 
us  in  the  first  place,  as  they  exercise  great  influence  on 

1  Potentia  generandi  und  Potentia  coeundi.  Wien,  1885,  p. 
24; 


112  SKXIAl.    IMI'OTKM'K. 

virility,  <!riinfcld  '  tdls  us  that  endoscopic  observation 
of  tin4  colliculus  seminalis  in  different  individuals  dis- 
closes varieties  differing  widely  in  color,  si/.e.  (-(insistency, 
and  vascularily.  These  differences  rest  on  a  pathologi- 
cal basis.  Continued  investigations  have  proved  that 
the  various  diseases  of  the  sexual  functions  of  man  are 
not  to  be  reduced  to  affections  of  the  nerve-apparatus 
exclusively,  but  that  they  may  also  be  dependent  on 
structural  diseases  of  the  colliculus  seminalis.  We  ob- 
serve hyperemia,  catarrlial  swell  ing,  and  hypertrophy  of 
the  colliculus  seminalis.  Hyperemia  is  almost  constantly 
met  in  onanists,  while  patients  afflicted  with  spermator- 
rhea  and  impotence  labor  under  various  grades  of  catarrh 
of  the  colliculus  seminalis. 

Other  diseases  of  the  sexual  organs  do  not  affect  vi- 
rility. Cancerous  or  tubercular  degeneration  of  the  tes- 
ticles does  not  impair  the  sexual  power.  I  have  often 
had  opportunities  to  examine  the  ejaculated  semen  of 
persons  afflicted  with  tuberculosis  of  the  testicle,  and 
never  found  spermatozoa  therein  ;  but  the  patients,  sub- 
ject almost  without  exception  to  frequent  pollutions, 
were  perfectly  virile.  Krzywicki  found  that  tuberculosis 
of  the  male  sexual  organs  mostly  begins  in  the  prostata ; 
less  frequently  affected  are  the  seminal  vesicles,  the  epi- 
didyinis,  and  the  vas  deferens  ;  seldom  the  testicles  ;  and 
very  rarely  the  penis  and  the  urethra.2  Klebs,  on  the 
contrary,  claims3  that  the  tubercle-bacillus  develops 


1  Die  Endoskopie  der  Harnrohre  und  Blase.  Deutsche  Chirm- - 
gie,  Stuttgart,  1881,  Lief.  51,  p.  172. 

2  Dr.  Hermann  Diirck,  Uber  den  gegenwartigen  Stand  der  Tuber- 
kulose-Forschung.  Wiesbaden,  1897,  p.  354. 

8  Ibidem,  p.  3.">r>. 


FORMS  OF  IMPOTENCE.  H3 

largely  in  the  testicular  tissue,  on  account  of  the  rich- 
ness of  the  blood  and  lymphatic  vascularity. 

Some  old  French  authors,  and  among  them  Lalle- 
mand,  assert  that  varicocele  can  cause  impotence.  Lal- 
lemand l  says  even  that  in  many  cases  of  varicocele  he 
found  the  testicles  very  small  and  soft,  and,  in  case  the 
veins  of  one  cord  only  were  affected,  the  corresponding 
testicle  would  be  less  fully  developed  than  the  other. 
Daily  experience  is  often  in  opposition  to  this  assertion. 
In  many  cases  of  varicose  affections  of  the  veins  of  the 
spermatic  cords  I  have  found  the  testicles  rather  enlarged 
than  otherwise.  Virility  I  never  found  impaired,  al- 
though patients  of  this  kind  are  not  exactly  vigorous  in 
sexual  matters,  and  are  very  much  predisposed  to  gon- 
orrheal  and  traumatic  inflammation  of  the  epididymis. 

There  is  a  great  number  of  poisons,  medicaments,  and 
foods  which  diminish  virility  temporarily  or  permanently. 
Some  manifest  their  injurious  effect  after  a  short  and 
moderate  use ;  others  do  not  show  themselves  until  after 
a  longer  or  immoderate  use.  In  this  respect  we  meet 
the  most  contradictory  statements  in  medical  works. 
Very  often  one  author  quotes  the  assertions  of  another. 
These  contrasts  are,  however,  easily  explained  if  we  take 
into  account  the  difference  of  the  effect  of  one  and  the 
same  medicament  on  different  individuals.  Take,  for 
instance,  quinin,  the  remedy  most  generally  used  until 
recent  times.  The  same  dose  given  to  two  equally 
vigorous  men  may  cause  in  the  one  scarcely  a  slight 
tinnitus  aurium  and  in  the  other  the  most  unpleasant 
effects. 

Alcohol,  especially,  exhibits  its  action  on  different  in- 


1  Op.  cit,  p.  171. 
8 


114  SEXUAL  IMPOTENCE. 

dividuals  differently.  There  are  people  who  in  ;i  rather 
high  degree  of  intoxication  can  accomplish  the  act  of 
coition,  whilst  with  others  the  sexual  organs  are  com- 
pletely panilyxed  by  the  consumption  of  so  small  a  quan- 
tity of  alcohol  that  it  wrould  not  affect  at  all  the  functions 
of  the  other  organs  of  the  body.  Thus  we  see  that  in 
this  respect  it  would  not  be  safe  to  lay  down  general 
rules  and  apply  them  in  all  cases ;  but  we  would  rather 
make  this  the  subject  of  our  next  discussion. 

Alcohol  in  general  diminishes  the  sexual  power,  ac- 
cording to  the  strength  of  the  article  consumed.  Alco- 
hol is  least  concentrated  in  beer,  and  yet  beer  is,  as 
a  matter  of  fact,  very  unfavorable  for  virility.  Gallant 
ladies  are  well  aware  of  this,  and  it  is  only  an  excep- 
tion for  them  to  serve  beer  to  their  lovers.  Too  hasty 
an  ejaculation  may  be  delayed  by  a  moderate  consump- 
tion of  beer,1  while  an  intemperate  absorption  of  the 
same  liquid  will  hinder  erection. 

But  why  is  beer  disadvantageous  to  coition  ?  Alcohol 
is  of  consequence  only  when  consumed  in  large  quanti- 
ties, and  yet  we  see  that  very  light  qualities  of  beer  are 
perhaps  worse  for  virility  for  the  time  being  than  heavy 
beer.  Lupulin  cannot  be  of  importance  either,  as  the 
quantity  is  too  insignificant,  and  in  cases  where  the  effi- 
cacy of  lupulin  is  desirable,  it  is  generally  without  effect. 
Therefore  the  effect  of  lupulin  is  not  so  prompt  and  sure 
as  that  of  beer.  I  think  that,  in  an  immoderate  con- 
sumption of  beer,  both  alcohol  and  lupulin  (?)  are  of  less 
importance  than  the  great  quantity  of  liquid  consumed, 
which  causes  frequent  urination  and  has  a  relaxing 
effect  on  the  parts  under  consideration.  Dr.  Lehmaim. 

1  Curschmann,  op.  cit.,  p.  535. 


FORMS  OF   IMPOTENCE. 

of  Munich,1  ascribes  the  diuretic  effect  of  beer  to  the 
greater  quantity  of  liquid,  assisted  by  the  influence  of 
alcohol  upon  the  heart.  It  is  noticeable  that  erection 
is  slower  immediately  after  urination  than  some  hours 
later.  This  observation  suggests  that  sexual  organs 
active  in  erection  may  be  temporarily  disturbed  in  their 
function  by  the  evacuation  of  large  quantities  of  urine, 
repeated  at  short  intervals. 

A  moderate  consumption  of  beer  is  rather  advan- 
tageous for  the  act  of  coition,  and,  in  wedlock,  where  I 
ascribed  the  absence  of  children  to  a  possible  frigidity 
of  the  wife,  I  have  advised  the  husband  to  take  some 
beer  before  coition,  because  I  thought  that  by  thus  pro- 
longing the  act  the  wife  might  be  roused  out  of  her 
reserve  and  become  more  liable  to  conception.  The 
result  has  justified  this  supposition  in  one  case  at  least. 
These  observations  would  also  help  to  explain  the  large 
families  in  countries  where  beer  is  the  habitual  beverage, 
as  in  Bohemia  and  Bavaria. 

The  effect  of  wine  in  this  respect  is  exceedingly  dif- 
ferent, varying  with  the  kinds  of  wine  as  well  as  with 
the  individuals  consuming  them.  Here  again  my  obser- 
vations have  proved  that  wines  with  diuretic  tendency 
affect  the  sexual  capacity  for  the  time  being  more  than 
do  other  wines.  Some  strong,  dark-colored  wines,  such 
as  certain  kinds  of  Californian,  Bordeaux,  Malaga,  Dalma- 
tian, Smyrnian,  etc.,  and  also  some  of  the  stronger  white 
wines,  especially  the  Muscatel,  if  consumed  moderately, 
have  almost  an  aphrodisiac  effect ;  whilst  others,  and 
particularly  champagne,  exercise  an  almost  paralyzing 


1  Die  Ursache  der  bekannten  diuretischen  Wirkung  des  Bieres. 
Wiener  med.  Presse,  1887,  No.  42. 


116  SEXUAL  IMPOTENCE. 

influence  on  the  centers  of  erection,  or,  directly,  on  the 
;ipp;iratus  of  erection,  as  they  increase  the  libido  scxnalis. 
but  check  the  erection. 

In  brandy  and  liquors  the  quantity  of  alcohol  only 
comes  into  consideration,  and,  though  it  may  be  larger 
Mian  that  in  wine  or  beer,  it  tends  to  increase  rather 
than  diminish  the  sexual  power,  if  the  same  time  for 
subsidence  has  been  allowed  in  both  cases  of  con- 
sumption. 

At  any  rate,  the  ancient  Latins  were  right  only  as  fur 
as  the  woman  is  concerned  when  they  said,  "  Sine 
Cerere  et  Baccho  friget  Venus,"  "  Luxuriosa  res  vinnm." 
"  ut  vino  calefacta  Venus,  turn  saevior  ardet  luxuries," 
etc. 

Considering  the  first  exciting  and  subsequent  sedative 
effect  of  coffee  and  of  tea,  an  immoderate  use  of  the 
same  might  injure  virility. 

Some  authorities  assert  that  smoking  is  injurious  to 
virility,  but  it  is  very  difficult  to  form  a  correct  opinion. 
Schtscherbak's  searching  investigations  regarding  the 
influence  of  tobacco  on  the  nervous  centers l  have  re- 
sulted only  in  the  assertion  that  immoderate  smoking, 
like  the  internal  use  of  nicotin,  undoubtedly  affects  the 
nervous  centers;  but  it  is  difficult  to  determine  what 
influence  is  exerted  on  the  centers  of  the  sexual  func- 
tions. In  acute  intoxication  with  nicotin,  copulation  is 
out  of  the  question,  but  when  the  symptoms  of  poison- 
ing have  passed,  virility  is  exactly  in  the  same  condition 
as  before.  Chronic  intoxication  with  nicotin,  to  which 
one  may  be  addicted  for  many  years  with  impunity, 


1  K  voprosu  o  vlijaniji    nikotina  i  kurcnija  tabaku  na  nervnie 
centri.    Vratch,  1887,  Nos.  4-9. 


FORMS  OF  IMPOTENCE.  H7 

seems  not  to  injure  virility,  as  very  great  smokers  may 
indeed  be  quite  as  great  in  sexualibus.  A  thirty-year- 
old  Servian  told  me  he  had  by  experience  found  that 
his  virility  was  seriously  injured  when  he  discontinued 
smoking-  cigareflos.  This  might,  however,  be  merely 
imaginary. 

The  habit  of  snuff-taking,  now  becoming  less  com- 
mon, is  more  likely  to  injure  virility,  as  it  weakens  the 
sense  of  smell,  and  the  odor  of  woman  plays  an  impor- 
tant role  in  sexual  matters,  as  is  well  known.  Galopin,1 
speaking  of  snuff  takers,  says,  "  If  they  are  gourmands, 
they  deprive  themselves  of  the  bouquet  of  their  dishes 
and  wines  ;  if  they  are  young  and  vigorous,  they  deprive 
themselves  of  the  pleasant  odor  of  a  beloved  wife  or 
mistress,  as  well  as  of  a  thousand  pleasures  which  the 
olfactory  sense  of  a  clean  and  healthy  man  procures." 
But  snuff  users  have  little  chance  with  ladies  nowadays, 
as  they  unquestionably  diffuse  a  disagreeable  odor  about 
themselves. 

There  are  foods,  solid  and  liquid,  that  are  said  to 
cause  temporary  impotence,  but,  in  my  opinion,  this 
rests  more  or  less  on  popular  belief  only ;  and,  after  all, 
virility  must  be  at  a  low  ebb  when  it  can  be  checked  by 
eating  Lima  beans,  lettuce,  etc. 

There  are  many  popular  means  of  subduing  amorous 
desire  for  a  time.  In  Bosnia  the  moon-flower,  under 
the  name  of  "  Neven,"  is  highly  prized  as  a  powerful 
anaphrodisiac.  Women  make  their  husbands  take  it 
in  the  form  of  medicine,  and  they  also  put  the  blossoms 
among  the  linen  of  husbands  about  to  go  on  a  journey. 

In  France  digitalis  is  said  to  have  similar  renown,  and 

1  Le  parfum  de  la  femme.     Paris,  1886,  p.  39. 


118  SEXUAL  IMPOTENCE. 

Campbell  Black  finds  this  virtue  of  digitalis  very  com- 
prehensible, as  it  stimulates  llemak's  fibers. 

We  meet  with  the  most  contrary  statements  about 
medicaments  reputed  to  have  an  injurious  influence  on 
virility.  Our  best  observations  are  on  morphin,  which, 
according  to  Levinstein,1  after  first  increasing  sexual 
excitability,  affects  it  finally  in  the  opposite  manner. 
An  injection  of  morphin  always  has,  on  persons  who  are 
not  accustomed  to  it,  the  effect  of  increasing  sexual 
excitement  and  vigor.  Rosenthal 2  states  that  injections 
of  morphin  of  medium  strength  (0.03-0.06  per  day) 
produce  unusual  hilarity  and  affability,  heightened  sexual 
excitability,  increased  refinement  of  the  sense  of  touch, 
etc., — all  symptoms  little  known  and  appreciated. 

In  Persia  opium  is  said  to  be  used  as  an  aphrodisiac.3 
This  is  in  accord  with  the  observations  made  on  opium- 
smokers,  who  are  extraordinarily  vigorous  sexually  at 
first,  their  virility  beginning  to  fade  when  the  general 
marasmus  always  following  this  fatal  habit  reaches  a 
certain  degree. 

Morphin,  opium,  and  cannabis  Indica  have  long  since 
ceased  to  be  used  for  therapeutic  purposes  only,  there 
being  a  large  number  of  persons  for  whom  the  very  ex- 
tensive use  of  these  drugs  has  become  an  indispensable 
necessity.  Opium-smokers  and  hashish- eaters  sing 
real  hymns4  of  praise  to  these  poisons.  These  poisons 
are,  indeed,  pleasant  and  sure  means  of  suicide  for 
unhappy  peop'le  or  people  weary  of  life  in  this  world. 

1  Morphiumsucht.     Berlin,  1887,  p.  93. 

2  Untersuchungen  und  Beobachtungen  iiher  Morphiuinwirkung. 
Wiener  med.  Presse,  1886,  No.  49. 

3  Rosenthal,  op.  cit.,  p.  147. 

4  "  Oh,  just,  subtle,  and  mighty  opium  !" 


FORMS  OF  IMPOTENCE.  1\Q 

Their  habitual  use  can  be  recommended  to  those  only 
who  desire  to  commit  suicide.  Paralyzing  the  inhibitory 
nervous  centers  in  the  brain,  they  probably  thus  increase 
virility  at  first.  Dr.  L.  Passover1  has  observed  that  the 
long-continued  use  of  morphin  leads  to  atrophy  of  the 
genitals. 

There  are  also  the  most  contradictory  statements  con- 
cerning the  influence  of  arsenic  and  its  preparations  on 
the  virile  power.  Although  arsenic  has  a  different  effect 
on  different  individuals,  and  may  therefore  affect  their 
sexual  powers  differently,  yet  I  must  state  that  in  the 
very  frequent  use  I  have  made  of  arsenic  in  various  dis- 
eases, even  for  years  continuously,  I  have  never  observed 
a  diminution  of  sexual  vigor.  I  never  saw  a  change  in 
the  sexual  power  of  men  or  in  the  amorous  desire  in 
women,  even  in  cases  where  arsenic  had  some  disturb- 
ing effect,  or  where  it  did  not  produce  the  desired  change 
in  the  disease  under  treatment,  and  its  use  had,  in  con- 
sequence, to  be  discontinued.  On  the  contrary,  several 
of  my  patients,  who  owe  the  return  of  health  to  arsenic, 
have  with  their  health  also  recovered  their  virility ;  so 
that  I  do  not  hesitate  to  recommend  arsenic,  in  conjunc- 
tion with  other  remedies,  of  course,  in  certain  cases  of 
prostration,  and  also  in  impotence  when  it  has  been 
brought  on  by  such  prostration. 

Rosenthal 2  asserts  that  arsenic  exercises  an  unfavor- 
able influence  on  the  sexual  power  after  continued  use  ; 
but  this  is  so  only  with  the  inhabitants  of  towns,  whilst 
the  inhabitants  of  Alpine  regions  have  children  in  spite 
of  the  consumption  of  considerable  arsenic.  This,  in- 

1  Wiener  med.  Presse,  1893,  No.  7. 

2  Op.  cit.,  p.  151. 


120  SEXUAL  IMPOTENCE. 

deed,  seems  too  improbable.  The  same  writer  observed 
recovery  of  sexual  sensibility  at  the  beginning  of  the  use 
of  arsenic. 

Lead-poisoning,  especially  if  acute,  occasionally  causes 
impotence.  As  physician  of  a  large  association  of  typog- 
raphers I  had,  for  a  number  of  years,  the  opportunity 
to  convince  myself  of  the  excellence  of  the  observations 
made  by  Tanquerel  des  Planches,  and  of  those  made 
more  recently  by  Roubaud.1  I  never  noticed  a  diminu- 
tion of  virility  in  chronic  lead-poisoning  that  was  not  ac- 
companied by  some  other  effect  on  the  nervous  system. 

Long-continued  use  of  iodin  can  produce  atrophy  of 
the  testicles,  besides  that  of  other  glands  ;  but  such  cases 
are  exceedingly  rare,  and  entirely  denied  by  some  very 
experienced  syphilologists.  I  have  recently  had  f\v<> 
cases  where  the  use  of  potassium  iodid  had  exerted  a 
very  unfavorable  effect  on  virility. 

Prolonged  use  of  mercury  also  is  said  to  lead  to  atro- 
phy of  the  testicles.  Roubaud2  has  observed  this  in  the 
case  of  laborers  who  work  with  mercury. 

Salicylic  acid  and  its  preparations  unquestionably  im- 
pair sexual  vigor,  but  only  temporarily.  My  observa- 
tions have  convinced  me  that  men  are  temporarily  more 
or  less  impotent  during  the  use  of  salicyl  and  its  salts, 
which  are  so  frequently  employed.  The  experiments 
made  by  Kolbe  and  Dr.  Lehmann,3  in  Munich,  to  prove 
the  harmlessness  of  salicylic  acid,  have  not  had  any  re- 
sults with  regard  to  its  effect  on  virility. 


1  Op.  cit.,  p.  240. 
a  Op.  cit.,  p.  285. 

8  Beitrag  zur  Frage  der  Gesundheitsschadlichkeit  der  Salicyl- 
saure.     Med.-chir.  Rundschau.     Wien,  1887,  Heft  14)  p.  549. 


FORMS  OF   IMPOTENCE.  121 

Camphor,  lupulin,  antimony,  niter,  and  the  bromids 
are  also  said  to  have  an  unfavorable  influence  on  sexual 
vigor.  Krafft-Ebing J  says  in  this  respect,  "  Our  nomen- 
clature presents  a  large  list  of  anaphrodisiacs,  but  when 
we  practically  try  all  these  remedies  we  soon  convince 
ourselves  that  they  have  no  such  virtue,  or  very  little. 
This  is  true,  for  instance,  of  camphor,  belladonna,  and 
lupulin.  Of  somewhat  more  value  are  the  bromids  in 
large  doses.  No  effect  must  be  expected  from  doses  of 
less  than  six  grams. 

"  Monobromated  camphor  seems  to  be  of  quite  ex- 
ceptional value  as  an  anaphrodisiac.  Lupulin  is  not  to 
be  entirely  disregarded ;  only  it  must  be  given  in  doses 
of  over  one  gram  each,  if  any  effect  is  desired. 

"  Recently  antipyrin  has  been  employed  as  an  an- 
aphrodisiac, and  in  doses  of  two  grams  it  is  said  to.  exert 
a  sedative  effect  on  the  sexual  apparatus.  Hammond 
and  a  few  others  direct  our  attention  to  the  anaphro- 
disiac effect  of  sodium  nitrate.  Quite  recently  I  have 
treated  painful  sexual  excitation  with  doses  of  three  grams 
of  sodium  nitrate  pro  die,  and  have  succeeded  in  reducing 
it  to  a  minimum  thereby.'' 

Here  I  may  be  allowed  to  state  that  in  the  first  German 
edition  of  this  work,  which  appeared  in  1889,  I  directed 
attention  to  antipyrin  as  a  possible  anaphrodisiac,  say- 
ing, "  Experiments  made  on  animals  having  proved  that 
antipyrin  has  an  irritating  influence  on  the  inhibitory 
reflex  centers,  it  would  be  very  interesting  to  examine  its 
influence  on  erectility." 

Van  den  Corput  has  ascertained  that,  besides  salicylic 

1  Die  Therapie  der  Geisteskrankheiten.  Wiener  med.  Presse, 
1891,  No.  22. 


122  SEXr.M.    IMI'DTKM'K. 

acid,  quinin,  menthol,  phenol — indeed,  almost  all  antisep- 
tics— diminish  sexual  viiior  inamarked  degree.  He  con- 
siders that  this  fact  may  have  its  explanation  in  I  lie 
inhihitory  influence  which  these  substances  exert  on  Un- 
formed elements  of  the  blood  and  on  the  spermatic  cells 
in  the  same  manner  as  on  the  lower  organisms.  The 
microscope  shows,  moreover,  that  these  substances  ren- 
der the  zoosperms  perfectly  motionless.  According  to 
Van  den  Corput,  the  diminished  sexual  vigor  is  to  be 
ascribed  to  anesthesia  and  paralysis  of  the  centers 
which  govern  the  sexual  function,  as  well  as  to  the 
sterilizing  and  antivital  influence  which  the  antiseptics 
have  on  the  spermatozoa.- 

INHERITED    PREDISPOSITION    TO    IMPOTENCE. 

There  is  an  apparent  inconsistency  in  speaking  of 
inherited  impotence,  and  yet  the  physician  meets  with 
many  cases  of  sexual  weakness  and  abnormal  conditions 
of  the  sexual  desire  which  after  closer  examination  he 
cannot  but  trace  to  inheritance  as  the  original  cause. 
Hoffmann *  says,  in  this  respect,  "  It  is  a  fact  that  there 
are  men  who  from  their  birth  either  lack  the  incito- 
motor  impulse  which  dominates  over  the  sexual  func- 
tions, especially  erectility,  or  in  whom  it  appears  abnor- 
mally impaired.'1 

It  is  quite  conceivable  that  such  a  condition  can  occur 
in  an  otherwise  normal  state,  this  condition  having  been 
called  by  the  ancient  Canonists,  who  were  very  expert 
in  such  matters,  "  Natura  frigida." 

Those  individuals  are  indeed  very  scarce  who  display 
complete  inertness  of  their  sexual  life,  although  possess- 

1  Lt-lirliiicli  dor  frorichtlichen  Medici n.     Wicu,  1881,  p.  M. 


FORMS  OF  IMPOTENCE.  123 

ing   sexual   organs  quite   normal  in  development   and 
function. 

Krafft-Ebing l  says  that  individuals  possessed  of  weak 
sexual  power,  in  whom  the  lack  of  sexual  instinct  can  be 
traced  to  the  cerebrum,  are  very  rarely  met  with,  and 
are  probably  without  exception  degenerate  beings  in 
whom  may  be  found  other  disturbances  in  the  function 
of  the  cerebrum,  psychically  degenerative  conditions,  and 
even  signs  of  structural  deterioration. 

There  are  numerous  families  the  male  members  of 
which  are  conspicuously  weak  in  sexualibus.  These  are 
not  always  sickly  people,  but  now  and  then  are  robustly 
built  and  of  healthful  appearance ;  most  of  them  have 
very  light  complexions  and  high-pitched  voices,  and  very 
often  show  no  other  weakness  than  that  of  the  sexual 
organs  and  functions. 

Sometimes  we  may  see  a  man  whose  father  was  sex- 
ually very  powerful,  but  who  was  begotten  at  a  time 
when  the  father's  virility  was  already  on  the  decline, — 
i.e.,  when  he  was  partially  impotent  in  consequence  of 
unwise  management  of  the  sexual  power,  though  it  may 
have  been  originally  great.  Again,  we  see  whole  families 
in  whom  education  has  implanted  principles  that  will 
ever  be  an  obstacle  to  the  proper  development  of  the 
sexual  instinct,  and  thus,  indirectly,  of  sexual  vigor. 

Circumstances  like  the  above  will  not  surprise  any  one 
who  is  acquainted  with  the  laws  of  transmission  by 
inheritance,  and  who  knows  that,  besides  forms,  quali- 
ties and  habits  also  may  be  inherited.  Even  recollec- 
tions are  said  to  be  thus  transmitted,  this  assertion 
coming  from  a  competent  source,  Exner.  As  fertility, 

1  Psychopathia  sexualis.     Stuttgart,  1886,  p.  29. 


124  SKXl'AL    IMl'UTKXCK. 

for  instance,  and  the  early  or  late  appearance  of  men- 
struation can  be  transmitted  from  mother  to  daughter, 
so  also  may  a  son  receive  from  his  fattier,  by  way  of  in- 
heritance, sexual  power  or  weakness. 

I  laeckel  lias  at teli) pled  to  formulate  laws  of  inheritance, 
and.  among  other  things,  he  says,  "In  all  organisms 
with  separated  sex.  the  primary  and  secondary  sex- 
characteristics  are  inherited  one-sidedly, — i.e.,  the  male 
descendants  resemble  the  father  in  the  aggregate  of  the 
essential  sexual  characteristics,  while  the  females  resem- 
ble more  the  mother." 

Just  as  there  is  a  great  difference  observable  in  the 
sexual  impulse  in  different  nations,  so  there  are  very 
great  differences  to  be  noticed  in  the  ardor  with  which 
the  sexual  instinct  announces  itself  in  different  families. 
There  are  sundry  links  of  connection  whereby  nature 
subdues  the  different  degrees  that  might  otherwise  be  too 
striking.  These  combinations  of  physiological  and  psy- 
chological phenomena  are  commonly  called  the  tempera- 
ment, and  we  all  know  that  children  have  generally  the 
temperament  of  one  or  the  other  or  even  of  both  the 
parents. 

An  innate  sexual  weakness  shows  itself  frequently,  yet 
not  always,  in  the  conformation  of  the  genitals.  Although 
the  structure  may  be  quite  normal,  they  are  nevertheless 
of  an  abnormal  flabbiness  and  paleness.  The  erectile 
tissue  is  not  very  firm ;  the  prepuce — if  there  is  not  a 
positive  phimosis — is  thin  and  moves  with  difficulty  over 
the  glans.  Such  individuals  are  generally  unassuming, 
and  make  true  and  devoted  husbands ;  nothing  in  them 
could  incite  them  to  act  otherwise. 

In  most  cases  this  weakness  can  be  traced  back  to 
childhood,  when  incontinentia  urinae  existed,  and  there 


FORMS  OF  IMPOTENCE.  125 

is  no  denying  the  connection  between  sexual  weakness 
and  incontinence  of  urine.  This  connection  Lallemand 
discovered  with  that  perspicacity  peculiar  to  him.  I  have 
always  found  that  children  suffering  from  incontinence 
of  urine  had  unusually  small  genitals,  and  when  I  found 
an  adult  affected  with  the  above  disease,  he  invariably 
was  either  quite  or  almost  impotent. 

Men  who  suffer  from  congenital  weakness  of  the  sexual 
organs  are  not  inclined  to  excesses  in  venery,  as  has 
already  been  stated ;  but  with  them  the  most  severe 
consequences  may  be  brought  about  by  sexual  indul- 
gence to  an  extent  not  considered  immoderate  with 
others.  In  such  persons  insignificant  excesses,  or 
onanism  practised  for  a  short  time,  will  result  in  frequent, 
and  to  a  certain  degree  incurable,  involuntary  seminal 
losses  together  with  a  great  enfeeblement  of  every  sexual 
power. 

The  different  grades  of  sexual  weakness  are  innumer- 
able, and  whilst  one  man  may  scarcely  show  any  signs 
at  all,  another  exhibits  from  the  very  beginning  the  most 
decided  sexual  decrepitude.  We  shall  therefore  be  right 
in  asserting  that  the  different  degrees  of  sexual  vigor,  or 
of  resistance  against  excess  in  venery,  rest  principally 
on  hereditary  differences ;  for  sexual  vigor  or  weakness 
is  oftener  inherited  than  is  usually  admitted. 

The  individual  differences  in  sexual  feelings  and  sen- 
sations are  perfectly  obvious.  One  individual  may  live 
for  sexual  enjoyment  alone,  all  his  actions  keeping  in 
view  that  one  main  object, — viz.,  sexual  gratification, 
which  he  enjoys  to  a  degree  of  ecstasy.  Another  may 
remain  almost  indifferent  in  regard  to  love  and  woman, 
may  consider  coitus  a  necessary  evil,  and  while  per- 
forming it  may  be  thinking  of  some  other  affair. 


12(>  SEXUAL    IMI'OTK.NCK. 

You  may  meet  with  individuals  who,  with  robust  con- 
stitutions and  well  developed  genitals,  have  from  their 
youth  shown  comparatively  little  taste  for  sexual  enjoy- 
ment,— individuals  who  are  not  easily  tainted  by  the  bad 
example  of  onanism,  and  who,  later  in  life,  exhibit  a  cer- 
tain reserve  in  respect  to  the  other  sex.  With  some. 
and  they  are  probably  rare  exceptions,  this  absence  of 
sexual  desire  has  even  reached  the  point  of  disgust. 
Such  men  are  shocked  by  a  somewhat  licentious  ex- 
pression ;  they  are  amazed  at  the  excesses  of  others, 
and  look  upon  love  merely  as  the  means  of  bringing 
forth  children.  This  congenital  disinclination  for  sexual 
pleasure  is  called  frigidity,  and  may  become  an  obsta- 
cle to  virility,  or  it  may  render  copulation  possible  only 
under  specially  favorable  circumstances. 

Krafft-Ebing1  ranks  this  frigidity  among  Hie  nnmises 
that  have  their  seat  in  the  brain,  and  calls  it  anaesthesia 
sexualis,  absence  of  sexual  instinct,  which  renders  inef- 
fectual every  organic  impulse  starting  from  UK;  organs 
of  generation,  as  well  as  every  fancy,  every  visual,  audi- 
tory, and  olfactory  sensation  that  such  individual  may 
experience  in  this  one  direction. 

Only  congenital  frigidity  can  prove  a  serious  hindrance 
to  the  development  of  virility,  whilst  frigidity  which  is 
sometimes  the  result  of  a  certain  mode  of  education 
really  yields  to  the  first  sexual  desires  that  assert  them- 
selves positively ;  here  principles,  resolutions,  and  vows 
give  way. 

Again,  there  are  individuals  who,  with  vigorous  con- 
stitutions, normal  development  of  the  genitals,  and  very 
energetic  sexual  desires,  nevertheless  become  tempo- 

1  Op.  cit.,  p.  25. 


FORMS  OF  IMPOTENCE.  127 

rarily  impotent,  where  we  can  find  no  other  cause  than 
an  inherited  general  or  sexual  nervousness  which,  at  the 
given  moment,  either  excites  the  inhibitory  centers  of 
erection  to  an  abnormal  activity  or  sets  the  nerve-centers 
of  erection  out  of  function.  Persons  of  this  category 
are  mostly  from  families  where  cerebral  and  nervous 
diseases  are  hereditary ;  albeit  Beard  asserts  that  chil- 
dren of  neurasthenic  parents  are  generally  unaffected 
in  that  direction.  The  children  will  probably  remain 
healthy  when  parents  suffer  from  acquired  neurasthenia ; 
but  when  this  disease  itself  is  congenital  or  has  appeared 
in  the  place  of  some  other  hereditary  disease  of  the 
brain  or  nerves,  then  there  is  no  doubt  that  such  condi- 
tions are  transmitted  from  generation  to  generation. 
No  one  can  assert  that  there  are  no  neurasthenic  chil- 
dren. 

In  general,  the  disposition  to  neuroses  shows  many 
varieties.  There  are  persons  who  can  make  enormous 
exertions  in  mental,  physical,  and  sexual  matters  with- 
out being  affected  by  neuroses,  whilst  a  high  degree  of 
neurasthenia  will  visit  others  after  only  a  slight  effort  in 
these  directions.  Therefore  the  different  injurious  acts 
must  be  considered  as  bringing  about  the  occasion  for 
the  disease,  whilst  the  positive  or  effective  and  real  cause 
must  be  looked  for  in  the  congenital  predisposition  to 
nervous  diseases.  Perfectly  robust  and  vigorous  persons 
may  be  affected  by  this  predisposition  in  a  very  high 
degree.  The  special  predisposition  to  neurasthenia  may 
be  so  intense  that  moderate,  nay,  even  infrequent,  inter- 
course has  an  injurious  effect. 

A  similar  condition  is  observed  in  epileptics,  though 
very  seldom,  it  is  true.  I  have  known  such  an  unfortu- 
nate one  who  had  an  attack  after  every  ejaculation  of 


128  SEXUAL  IMPOTENCE. 

sperm.  Continued  use  of  potassium  bromid  quelled  the 
sexual  activity  and  stopped  the  attacks ;  but  whenever 
a  pollution  took  place,  it  was  followed  by  an  epileptic 
attack,  however  large  a  dose  of  potassium  bromid  or 
sodium  bromid  had  been  taken.  In  such  cases,  which 
occur  but  rarely,  castration  may  be  suggested. 

Of  the  limited  number  of  forms  of  congenital  impo- 
tence we  have  yet  to  mention  one, — viz.,  perverse 
sexual  sensation.  This  disease  is  generally  congenital, 
the  severe  forms  always ;  while  the  lighter  forms  may 
also  be  acquired.  The  subjects  are  generally  persons 
affected  by  psychopathia,  who  can  satisfy  their  sexual 
desire  only  in  a  peculiar  manner.  Such  persons  are  not 
impotent  in  the  true  sense  of  the  word,  as  erection  is 
not  lacking  with  them,  but  is  often  very  vigorous,  and 
yet  they  must  be  called  impotent  because  they  are  not 
capable  of  performing  coitus  in  the  normal  wray. 

Krafft-Ebing  gives  in  his  work,  which  we  have  already 
quoted,  an  exhaustive  description  of  sexual  psychopathy, 
and  he  classes  the  perverse  sexual  sensation  (which  he 
calls  the  paresthesia  of  sexual  sensation)  together  with 
the  sexual  neuroses  having  their  seat  in  the  brain. 
Magnan1  endeavored  to  classify  the  various  forms  of 
diseased  sexual  instinct,  and,  localizing  them  in  the 
central  nervous  system,  distinguishes  four  groups. 

Keeping  in  view  the  object  of  this  work,  we  shall  be 
very  brief  in  discussing  this  disease,  which  is  both  im- 
portant and  interesting  to  every  physician.  Numerous 
observations  and  investigations  were  required  to  lead 
to  a  knowledge  of  this  form  of  disease  ;  a  study  carried 


1  Des  anomalies,  des  aberrations  et  des  perversions  sexuelles. 
Paris,  1885. 


FORMS  OF  IMPOTENCE.  129 

on  during  centuries  was  necessary  to  protect  many  an 
unfortunate  being  from  punishment  because  of  disease. 
Even  in  our  day  there  is  much  to  be  learned  before  a 
correct  opinion  can  be  formed  of  many  a  case  of  this 
sort.  On  the  other  hand,  we  must  guard  against  being 
misled  by  a  false  love  for  humanity.  Society  is  in  the 
right  to  protect  itself  against  dangerous  individuals,  and 
it  is  justified  in  destroying  persons  who  assuage  their 
amorous  longings  in  murder  and  other  acts  of  cruelty. 

Krafft-Ebing  holds  that,  in  paresthesia  of  sexual  sen- 
sation, the  spheres  of  sexual  fancy  are  perversely  accen- 
tuated by  the  association  of  feelings  which  otherwise 
would  physiologico-psychologically  awaken  disgust,  being 
accompanied  by  pleasurable  sensations  ;  this  association 
may  reach  so  high  a  degree  as  to  become  passion.  The 
result  will  be  perverted  actions.  This  occurs  the  more 
readily  when  the  pleasurable  sensations,  having  reached 
the  height  of  passion,  inhibit  or  overpower  adverse  ideas 
with  corresponding  unpleasant  sensations;  also  when 
these  latter  cannot  be  roused  at  all  on  account  of  lack  or 
loss  of  the  moral,  esthetic,  and  righteous  perceptions.  I 
am  of  the  opinion,  however,  that  Krafft-Ebing  goes  too 
far  when  he  says,  farther  on,  "  We  must  declare  as  per- 
verse every  manifestation  of  the  sexual  instinct  which  is 
not  in  accordance  with  the  aims  of  nature, — i.e.,  with 
propagation."  At  any  rate,  Krafft-Ebing  does  not  mean 
to  say  that  any  and  every  copulation  not  undertaken  for 
the  purpose  of  propagation  must  be  declared  as  a  mani- 
festation of  a  perverse  sexual  feeling;  for  then  there 
would  be  fewr  people  in  this  world  who  were  not,  are 
not,  or  may  not  be  affected  by  paresthesia  of  sexual 
sensation  as  thus  defined. 

If  this  perverse  sexual  sensation  is  congenital,  it  is  in 

9 


130  SKXUAL  IMPOTENCE. 

most  cases  accompanied  by  )>;irtii-ul;irly  vehement  or 
impetuous  manifestations  of  the  amorous  desires.  This 
abnormally  increased  sexual  desire,  which  Krafft-Ebing 
terms  hyperesthesis  of  I  he  sexual  sensation,  is  seldom  a 
disease  in  the  true  sense  of  the  word,  and  its  explanation 
is,  in  my  opinion,  to  be  found  rather  in  the  circumstance 
or  fact  that  abnormal  sexual  desires  can  be  carried  out 
only  occasionally  or  with  difficulty.  Besides,  the  affected 
individual  revolts,  in  proportion  to  his  moral  strength, 
against  the  satisfying  of  the  ever-increasing  lust, — say, 
for  murder  or  other  lusts  incomprehensible  to  men 
whose  volition  or  desires  are  in  a  normal  condition.  The 
individual  is  unable  to  control  himself  only  when  these 
perverse  sexual  sensations  have  reached  the  point  when 
they  must  be  called  hyperesthetic.  Then  a  crime  is 
committed. 

Persons  thus  affected  procure  satisfaction  of  their 
lusts  by  the  most  remarkable  means.  It  is  hardly  possi- 
ble to  introduce  order  or  a  systematic  classification  into 
the  sundry  forms  of  this  disease,  because  the  longer  we 
observe  and  investigate  the  more  new  forms  present 
themselves.  It  might,  however,  be  attempted  to  estab- 
lish four  groups  of  perverse  sexual  sensations,  according 
as  the  satisfaction  is  looked  for  in  perverse  acts — 

1.  On  persons  of  the  other  sex ; 

2.  On  persons  of  one's  own  sex  ; 

3.  On  animals ; 

4.  On  inanimate  objects. 

In  the  first  group  we  should  have  to  place  first  of  all 
lust-murder  and  similar  phenomena,  as,  for  instance,  dif- 
ferent acts  of  cruelty  to  females.  It  is  a  fact  long  known 
that  cruelty  and  voluptuousness  are  sometimes  associates; 
a  telling  witness  is  the  novel  "  Justine,"  by  Marquis  de 


FORMS  OF   IMPOTENCE.  131 

Sade.  Here  the  monster  pretends  even  to  pose  as  a 
type  with  his  perverse  lusts.  It  seems  to  me  extravagant, 
however,  when  Krafft-Ebing  speaks  of  voluptuous  kissing 
approaching  biting  in  a  chapter  made  up  of  lust-murder 
and  allied  phenomena.  It  certainly  is  only  by  individuals 
who  are  decidedly  psychopathic  that  real  cruelties  are 
performed  for  satisfying  sexual  lusts,  and  the  lust-mur- 
derers who  use  the  knife  and  the  dagger  are  all  without 
exception  suffering  from  mental  aberration. 

Several  years  ago  I  watched  a  case  of  this  nature. 
The  mother  of  a  poor,  fourteen-year-old  boy,  B.,  noticed 
that  the  body  of  her  son  was  covered  with  black  and 
blue  spots,  particularly  the  arms,  buttocks,  and  thighs. 
After  an  examination,  the  boy  confessed  that  his  fifteen- 
year-old  friend,  P.,  son  of  an  aristocratic  and  rich  family, 
had  induced  him  by  gifts  of  money  to  allow  himself  to 
be  pinched.  When  the  little  tormented  fellow  found  the 
pains  too  great  he  began  to  cry  and  scream,  whereupon 
his  torturer  commenced  striking  him  with  his  right  hand 
while  he  moved  his  left  quickly  to  and  fro  in  the  left 
pocket  of  his  trousers.  When  the  cruel  boy  was  after- 
ward brought  under  my  notice,  I  learned  that  he  suffered 
from  epileptic  fits  (epileptics  are  frequently  subject  to 
perverse  sexual  sensations).  He  was,  on  the  whole,  a 
well-behaved,  peaceable,  and  talented  child,  but  occa- 
sionally very  disobedient,  headstrong,  and  passionate. 
I  convinced  myself  besides  that  he  was  an  onanist.  When 
alone  with  me  he  confessed  that  torturing  his  friend, 
whom  he  liked  personally,  afforded  him  a  special  delight, 
and  that  the  ejaculation  which  he  brought  about  at  the 
same  time  was  much  more  pleasurable  than  when  caused 
by  masturbation  without  his  tormenting  any  one.  The 
grandfather  and  an  uncle  on  the  mother's  side  died 


132  SKXITAL   IMl'OTKXCK. 

in  an  asylum;  the  mother  \v;is  a  sufferer  from  hysterical 
attacks.  The  father  was  known  ;is  a  lii^li  liver:  two 
brothers  .and  sisters  died  at  a  tender  age  of  what  the 
mother  called  "  Fraisen''  (convulsions).  I  am  of  the 
opinion  that  the  boy,  whom  I  watched  for  some  time, 
will  meet  with  a  sad  fate  in  spite  of  all  the  care  and 
treatment  that  he  may  be  receiving. 

The  most  common  form  of  perverse  sexual  gratifica- 
tion is  that  which  manifests  itself  in  love  for  one's  own 
sex.  The  men  who  love  men  and  the  women  who  love 
women,  the  "  urnings"  by  birth,  are  probably  but  few, 
but  more  common  are  the  pederasts  and  the  priestesses 
of  Lesbian  love  from  necessity  and  lack  of  something 
better.  The  impossibility  of  satisfying  sexual  desire  in 
the  natural  way  in  educational  institutions,  convents, 
prisons,  on  board  ship,  etc.,  leads  many  persons  to  such 
perverse  acts.  More  frequent  than  is  generally  thought 
is  pederasty  between  husband  and  wife,  to  prevent  un- 
welcome progeny.  Some  persons  practise  it  with  pros- 
titutes to  avoid  contagious  diseases. 

This  is  the  kind  of  perverse  sexual  sensation  which, 
more  than  others,  can  be  and  is  acquired  by  people  who 
are  not  predisposed  by  inheritance,  but  who,  in  conse- 
quence of  blunted  senses  for  natural  charms,  sink  step 
by  step,  and  finally  find  pleasure  in  loathsome  and  dis- 
gusting acts.  Impotence  often  leads  men  to  this  vice,  and 
hence  it  is  generally  old  people  who  are  addicted  to  it. 

In  the  Orient  pederasty  is  very  common.  Even 
Moses  had  to  decree  capital  punishment  for  those  guilty 
of  this  crime.  Some  authors  think  it  is  frequent  there 
because  of  the  fact  that  in  Oriental  women  the  genitals 
relax  at  an  early  age  and  become  rather  capacious. 

If  love  for  one's  own  sex  has  for  its  cause  a  congenital 


FORMS  OF  IMPOTENCE.  133 

perverse  sexual  sensation,  the  subject  will  usually  show 
something  peculiar  in  his  character  and  appearance. 
His  mode  of  thinking  and  of  feeling  is  changed  so  as  to 
correspond  to  that  of  the  opposite  sex.  Most  of  these 
individuals  whose  perverted  senses  are  due  to  inheri- 
tance betray  their  inclination  by  their  conduct,  often  also 
by  the  garments  they  wear.  The  males  have  a  liking 
for  the  occupations  of  females,  and  vice  verva. 

Some  authors,  as  Gley  and  Magnan,  endeavored  to  ex- 
plain this  phenomenon  by  assuming  the  presence  of  the 
sexual  glands  of  a  male  associated  with  the  brain  of  a 
female.  Whatever  the  explanation  may  be,  it  is  a  proved 
fact  that  the  perverse  sexual  sensation  of  an  urning  is 
absolutely  independent  of  the  will,  and  that  many  such 
persons  have  gone  through  the  most  dreadful  struggles, 
but  could  not  escape  their  fate. 

Krafft-Ebing,  basing  his  conclusions  upon  his  expe- 
rience, contends  against  the  assertion  of  Tarnovsky,  that 
a  real  urning — i.e.,  one  afflicted  with  congenital  perver- 
sion of  the  sexual  life — may,  through  education,  be  freed 
from  his  morbid  sexual  inclination  and  led  to  a  normal 
sexual  life.  Krafft-Ebing  admits  that  a  good  education 
will  act  here  in  the  same  manner  as  in  a  man  with  nor- 
mal feeling  but  sensual,  and  will  enable  the  individual 
to  strive  toward  mastering  the  impulse,  avoiding  ped- 
erasty, and  counterbalancing  the  desire,  but  only  so  long 
as  this  perverse  desire  does  not  assert  itself  with  abnor- 
mal strength. 

The  third  group  of  sufferers  from  perverse  sexual  sen- 
sation are  the  so-called  Sodomites,  people  who  gratify 
their  lusts  with  animals.  Sodomy  was  part  of  the  re- 
ligious' cult  of  several  ancient  nations,  including  the 
Egyptians. 


134  SEXUAL  IMPOTENCE. 

A  man  may  by  different  causes  be  led  to  sodomy. 
Generally  it  is  weak-minded  persons,  cretins,  imbeciles,  or 
idiotic  people  who,  in  their  sexual  excitement,  have 
intercourse  with  animals.  This  excitement  may  occur 
periodically.  In  exceptional  cases,  also,  persons  ap- 
parently psychically  sound  may,  for  want  of  something 
better,  abuse  an  animal  if  the  occasion  is  offered  arid  if 
they  feel  sexually  excited.  Very  seldom  is  it  moral  deg- 
radation that  induces  a  man  or  a  woman  to  seek  an 
animal  for  the  gratification  of  amorous  desires,  but  fre- 
quently elderly  unmarried  women  use  dogs  for  various 
unsavory  purposes. 

I  had  an  opportunity  to  observe  a  case  of  sodomy.  In 
a  small  provincial  town  a  thirty-year-old  man,  an  army 
officer,  was  caught  in  the  act  of  gratifying  his  lust  with  a 
hen.  One  hen  after  another  had  perished  in  the  house, 
and  efforts  were  being  made  to  discover  the  cause. 
When  he  was  asked  in  court  how  it  came  that  he  had 
turned  into  a  cock,  the  defendant  suggested  that  the 
smallness  of  his  genitals  made  intercourse  with  women 
impossible.  An  examination  proved  the  assertion  to  be 
well  grounded.  The  individual  was  psychically  normal. 
Unfortunately,  I  neglected  at  the  time  to  make  a  search- 
ing examination  and  to  investigate  the  past  history  of  the 
case,  as  the  subject  had  not  much  attraction  for  me  at 
that  date  (1877). 

The  fourth  and  last  group  of  perverse  sexual  sensa- 
tion consists  of  those  who  satisfy  their  lusts  on  inanimate 
objects,  and,  of  course,  does  not  include  the  different 
kinds  of  onanism  with  manipulations  on  lifeless  things. 
The  observations  in  this  direction  are  not  always  quite 
reliable.  It  may  be  mentioned  merely  that  in  most 
cases  articles  of  women's  toilette,  such  as  linen,  night- 


FORMS  OF  IMPOTENCE.  135 

caps,  shoes,  etc.,  have  occasionally  the  power  to  excite 
sexually  and  to  satisfy  individuals  of  perverse  sexual 
feelings,  who  are,  as  a  rule,  by  inheritance  predisposed 
to  mental  diseases.  Krafft-Ebing l  says,  "  In  other  cases 
the  sexual  desire  is  roused  by  the  sight  of  a  woman's 
underwear,  and  is  satisfied  by  their  manipulation."  If 
the  center  of  ejaculation  is  in  a  state  of  irritable  weak- 
ness, the  mere  putting  on  of  such  clothes  suffices  ;  other- 
wise masturbation  must  lend  its  help.  Again,  some 
individuals  have  to  tear  these  articles  to  pieces  in  order 
to  cause  ejaculation. 

Tarnovsky  speaks  of  a  psychopathic  individual  find- 
ing sexual  gratification  in  the  manipulation  of-  peltry. 
Again,  isolated  cases  have  been  observed  where  stat- 
ues were  appealed  to  for  sexual  gratification.  Very 
instructive  are  a  number  of  cases  reported  by  Albert 
Moll.2 

Ghastly  and  horrible  is  the  defilement  of  corpses,  of 
which  even  as  ancient  an  author  as  Herodotus  has 
spoken.  One  cannot  easily  imagine  that  any  person  in 
sound  mind  could  be  capable  of  such  an  act. 

And  now,  at  the  conclusion  of  our  discussion  on  the 
inherited  forms  of  impotence,  we  have  to  mention  some 
isolated  causes  of  psychopathic  conditions  by  which  the 
sufferers  may  be  rendered  temporarily  or  permanently 
impotent,  or  at  least  sexually  weak.  In  the  first  in- 
stance, idiots  possess  very  feebly  active  sexual  life,  which 
is  wanting  entirely  in  idiocy  of  high  grade.  Sometimes 
the  sexual  instinct  appears  periodically ;  but  then  it  is 
of  a  very  violent  character,  and  the  idiot,  resembling 

1  Op.  cit.,  p.  48. 

2  Untersuchungen  Uber  die  Libido  sexualis.     Berlin,  1897. 


136  SEXUAL   IMPOTENCE. 

then  a  wild  beast,  seizes  without  warning  the  nearest 
female,  even  though  she  be  his  own  mother. 

Finally,  for  the  sake  of  completeness,  we  should  note 
that  impotence  and  heightened  sexual  impulse  accom- 
pany some  mental  diseases. 

NEURASTHENIC    IMPOTENCE. 

Under  this  collective  name  we  shall  discuss  all  flic 
forms  of  impotence  dependent  on  a  gradual  degeneration 
of  the  sexual  nerves  and  their  centers.  The  present 
state  of  science  does  not  disclose  the  character  of  this 
degeneration. 

Before  Beard  every  symptom  of  general  neurasthenia 
used  to  be  named  and  described  as  a  distinct  disease.  In 
like  manner  the  symptoms  of  neurasthenic  impotence 
were  described  as  special  forms  of  disease  and  as  special 
forms  of  impotence.  People  formerly  spoke,  and  still 
do  speak,  of  irritable  weakness,  psychical  and  relative 
impotence.  Now,  as  the  name  "  neurasthenia"  has  be- 
come so  fashionable,  and  as  the  neuro-pathologists 
employ  this  collective  name  for  forms  of  diseases  that 
were  hitherto  designated  by  distinct  names,  we  shall 
follow  their  example  and  describe  under  the  name  of 
neurasthenic  impotence  all  forms  of  sexual  weakness 
the  origin  of  which  we  cannot  trace  to  any  structural 
change  in  the  organs  of  erection  and  secretion,  or  which 
cannot  be  ascribed  to  any  distinct  appearance  of  disease 
in  the  body  or  in  the  so-called  psyche. 

Time  will  answer  the  question  whether  by  this 
change  we  shall  gain  any  benefit  for  the  therapeutics  of 
these  diseases.  At  any  rate,  a  clear  distinction  between 
those  forms  of  impotence  that  arise  merely  from  an  af- 
fection of  the  nerves  or  nervous  centers  of  the  sexual 


FORMS  OF  IMPOTENCE.  137 

apparatus  and  the  other  forms  of  impotence  must  be  of 
great  importance  in  the  development  of  therapeutics. 

Beard's  fame  has  disturbed  the  peace  of  mind  of  our 
authors.  Every  day  a  new  name  is  invented  and  dished 
up  for  the  already  perplexed  practitioner.  Every  author 
has  a  new-fledged  name  for  the  old  phenomena  of  dis- 
ease, and  our  hope  must  be  that  these  new  names  will 
not  all  live  to  an  old  age. 

Impotence  as  a  consequence  of  sexual  neurasthenia 
either  has  its  origin  in  a  congenital  predisposition  or  else 
is  acquired.  We  have  already  spoken  of  the  congenital 
forms,  and  shall  now  give  our  attention  mainly  to*  the 
acquired  forms  of  sexual  neurasthenia. 

Neurasthenic  impotence  is  less  often  caused  by  dis- 
ease than  by  bad  management  of  the  natural  sexual 
power, — i.e.,  by  excess  in  venery,  either  for  the  time 
being  or  habitually,  by  onanism,  and  occasionally  by 
abstinence  of  longer  or  shorter  duration. 

Every  man's  virility  has  its  limits,  and  these  must  be 
respected,  for  daily  experience  teaches  us  that  impotence 
is  most  frequently  caused  by  abuse.  At  the  same  time 
we  must  insist  that  the  expression  "  excess  in  venery" 
has  been  misapplied  without  limit  by  most  of  our  authors. 
To  form  a  correct  opinion  in  individual  cases,  and  to 
distinguish  between  sexual  excess  and  normal  though 
frequent  use,  one  must,  first  of  all,  possess  personal  ex- 
perience in  the  matter,  and  must  have  observed  a  good 
number  of  bon  vivants.  Even  the  most  extensive  expe- 
rience will  not,  in  all  cases,  enable  us  to  decide  whether 
or  not  excess  has  taken  place.  Lallemand  says,1  "  I 
call  abuse  every  abnormal  use  of  anything.  Concerning 


1  Des  pertes  seminales,  tome  i.  p.  315. 


138  SEXUAL  IMPOTENCE. 

the  generative  organs,  I  understand  abuse  to  be  every 
irregular,  premature,  or  other  action  which  cannot  re- 
sult in  the  propagation  of  the  race.  There  are  no  doubt 
many  connecting  links  between  those  abuses  and  sexual 

excesses." 

Lallemand,  therefore,  distinguishes  bet  \veen  an  abuse 
of  the  sexual  power  and  excess  in  venery,  and  we  shall 
retain  this  very  sound  distinction,  as  it  will  afford  a 
special  clearness  to  the  subject  under  discussion.  This 
is  the  more  desirable  because  the  two  expressions  thus 
separated  to  define  very  different  things  have  usually 
been -confounded  and  made  the  object  of  the  most  diverse 
and  remarkable  views. 

Suppose  an  individual  to  have  enjoyed  coition  without 
exceeding  his  natural  power  and  without  having  had 
either  the  desire  or  the  possibility  for  propagation,  then, 
strictly  speaking,  he  may  be  said  to  have  committed  an 
abuse  of  his  sexual  power,  but  certainly  not  an  excess. 
I  believe  that  a  medical  man  need  not  concern  himself 
about  the  abuse  of  virility  in  a  natural  manner.  Let 
each  be  his  own  judge,  and  if  any  one  requires  a  judge, 
let  him  address  himself  to  his  confessor. 

If  we  choose  to  call  an  abuse  of  the  sexual  power 
every  act  of  coitus  that  has  not  been  undertaken  with 
the  possibility  or  even  the  intention  of  propagation,  then 
abuse  of  virility  will  be  carried  on  as  long  as  there  is  a 
sensible  and  virile  man  in  the  world,  and  wre  need  not 
feel  alarmed  about  it.  If  coition,  however,  were  to  be 
accomplished  only  when  a  woman  is  to  be  impregnated, 
then  most  men  would  become  impotent  from  continence, 
and  a  great  many  would  become  insane.  My  conviction 
is  that  the  physician  is  concerned  with  excesses  in  venery 
only  when  they  injure  the  body. 


FORMS  OF  IMPOTENCE.  139 

Lallemand1  defines  excess  in  venery  in  these  few 
words :  "  L'usage  pousse  au-dela  des  besoins  reels." 
This  definition,  however,  admits  of  more  than  one  ex- 
planation, since  the  meaning  "  real  wants"  is  indefinite. 
Is  a  man  actually  to  wait  until  the  sexual  instinct  awakens 
without  any  action  of  his  own?  If  so,  many  men  en- 
gaged in  serious  occupation  would  never  come  to  sexual 
gratification.  The  pleasures  of  love  would  then  hardly 
be  reserved  for  any  one  except  the  man  of  leisure  and 
the  idler. 

I  think  a  better  definition  would  be  this :  Excess  is 
coition  for  which  an  effort  is  required.  Coitus  easily 
performed  and  for  which  the  individual  does  not  require 
long  preparation  can  never  be  called  excess,  even  if  no 
"  real  want"  is  to  be  satisfied.  We  eat  and  drink  very 
often  without  feeling  imperious  hunger  or  thirst,  and  yet 
no  one  would  pretend  that  excess  has  been  committed. 
It  is  simply  meal-time,  and  we  do  not  feel  the  least  dis- 
like for  the  viands  that  have  such  an  agreeable  odor  and 
a  still  more  pleasing  taste. 

For  the  explanation  of  the  specially  injurious  effects 
of  sexual  intercourse  for  which  more  or  less  effort  is  re- 
quired, we  must  look  to  those  cases  where  copulation  or 
even  excess  is  attempted  or  accomplished  with  uncon- 
genial, nay,  repulsive,  mates.  It  is  simply  incompre- 
hensible that  Deslandes  and  Hunter  could  say  that 
copulation  with  a  woman,  not  rousing  any  special  feel- 
ing in  the  man,  is  not  so  hurtful  as  when  passionate 
love  accompanies  the  act.  Every  day's  experience  con- 
vinces us  of  the  contrary.  Men  who,  for  some  reason 
or  other,  give  too  frequent  proofs  of  very  ardent  love  to 

1  Op.  cit.,  p.  489. 


140  SEXUAL   IMPOTENCE. 

a  woman  really  disliked,  suffer  comparatively  much  more 
from  it  than  those  who  give  to  a  beloved  or,  at  least, 
sympathetic  being  proofs  of  their  love  by  still  more 
frequent  embraces. 

It  must  also  be  observed  here  lluit  those  forms  of 
impotence  that  arise  from  sexual  excess,  and  particu- 
larly from  too  frequent  coition,  are  mostly  of  a  slighter 
and  transient  character,  and  comparatively  easy  to  cure. 
Only  after  protracted  abuse  may  those  conditions  occur 
that  lead  to  real  and  sometimes  incurable  impotence. 
the  so  called  paralytic  impotence. 

Man,  as  an  animal  gifted  with  reason,  has  reached 
special  excellence  in  various  spheres.  In  many  a  prov- 
ince of  knowledge  and  art  he  has  left  marks  of  his  in- 
ventive genius.  In  most  things  it  took  him  thousands 
of  years  to  pry  into  and  lay  open  the  secrets  of  nature. 
Some  fields  are  still  left  fallow  by  his  investigating 
power ;  he  has  never  felt  a  desire  to  turn  his  attention 
toward  them.  He  possesses  quite  perfect  knowledge  of 
the  means  of  abuse  of  his  sexual  power,  and  he  knows 
how  to  commit  all  kinds  of*^  sexual  excesses.  This 
knowledge  he  acquired  at  so  early  a  date  that  even  the 
very  oldest  of  monuments  of  human  culture  tell  of  it  as 
of  something  that  had  existed  since  the  most  remote 
antiquity.  Modern  culture,  in  spite  of  all  the  lamenta- 
tions of  tiresome,  old,  or  hypocritical  moralists,  is  not  to 
be  blamed  for  the  almost  universal  abuse  of  the  sexual 
power.  This  has  been  transmitted  to  us,  like  many 
other  detrimental  inheritances,  by  preceding  ages,  and 
our  time  suffers  under  it  neither  more  nor  less  than  it 
does  from  many  other  bad  qualities,  perverse  notions, 
and  unsuitable  institutions  handed  down  to  us  by  our 
ancestors.  Moreover,  we  find  among  uncultivated  nations 


FORMS  OF   IMPOTENCE.  141 

the  most  remarkable  and  cunningly  invented  sexual  per- 
versities. The  charm-rings  in  use  among  some  of  our 
arrant  rakes  are  mere  toys  in  comparison  with  the  so- 
called  "  ampallang"  1  of  a  few  savage  tribes.  The  only 
merit  that  can  be  claimed  by  our  present  time  is  that  we 
have  laid  bare  and  shown  in  its  true  light  the  weak- 
ness of  man  in  committing  excesses  in  venery,  and  that 
we  have  exerted  ourselves  in  discovering  remedies  for 
checking  this  devastating  evil. 

I  am  convinced  that  the  united  efforts  of  all  the  better 
elements  of  our  society  will  succeed  in  preserving  the 
nobler  part  of  it  from  excesses  in  sexual  gratification ; 
and,  though  I  do  not  expect  to  see  an  end  of  the  ex- 
cesses in  venery,  I  hope  to  see  onanism  curtailed  in  the 
number  of  its  victims,  though  it  may  be  only  in  the 
better  circles  of  society.  This  latter  expression,  "  better 
circles,"  I  wish,  rwwever,  not  to  be  understood  in  the 
sense  commonly  attached  to  it  nowadays. 

In  general,  and  leaving  out  of  question  the  perverse 
manifestations  of  amorous  desire  of  which  we  have 
already  spoken,  it  is  found  that  excesses  in  sexual  en- 
joyment may  take  place  in  two  distinct  ways.  There  is 
excess  in  copulation,  and  that  of  self-abuse  or  onanism. 

It  is  hard  to  determine  at  which  point  of  natural  coition 
normal  indulgence  ends  and  abuse  commences ;  and  to 
fix  on  a  certain  frequency  of  sexual  intercourse  seems 
merely  ridiculous.  Regarding  the  frequency  of  copula- 
tion to  be  allowed  we  shall  not  easily  agree  ;  for,  as  there 
was  a  Martin  Luther  who  allowed  two  conjugal  acts  per 
week,  we  have  also  an  Acton  who  will  allow  one  per 
week,  and  a  queen  of  Aragon  who  demanded  six  per 

1  Mantegazza,  Gli  amori  degli  uomini.   Milano,  1868,  vol.  i.  p.  108. 


142  SEXUAL  IMPOTENCE. 

day.  The  Talmud  prescribes  one  act  of  coitus  per  day 
for  a  man  in  comfortable  circumstances,  who  is  strong 
and  has  no  heavy  work  to  perform.  It  allows  l\\<>  per 
week  fora  mechanic,  and  only  one  per  week  for  scholars 
and  laborers. 

In  the  consideration  of  this  question  there  must  be 
kept  prominently  in  view  the  great  and  various  differences 
in  individuals.  Just  as  the  digestive  power  differs  in 
different  men,  and  the  act  of  thinking  is  not  of  the  same 
rapidity  in  all,  so  also  is  the  sexual  capacity  of  very  dif- 
ferent grades.  The  appetite  of  one  person  may  be  per- 
fectly satisfied  by  a  small  quantity  of  food,  anything 
beyond  that  causing  discomfort  or  nausea.  Another 
person  digests  much  larger  quantities  of  food  without 
inconvenience.  A  third  may,  after  coitus,  be  disabled 
for  a  fortnight,  whilst  a  fourth,  after  coition  repeated 
several  times  at  short  intervals,  can  hardly  await  the 
next  happy  hour  of  love.  I  do  not  think  I  am  in  error 
in  making  the  assertion  that  there  is  no  excess  as  long 
as  no  unusual  effort  is  required,  no  special  means  is 
made  use  of  for  rousing  sexual  passion,  and  no  feeling  of 
fatigue  or  faintness  is  experienced,  regardless  of  the 
number  of  copulations,  even  if  repeated  at  short  in- 
tervals. 

In  the  determination  of  sexual  excess,  a  despicable, 
narrow-minded  way  of  moralizing  has  come  down  from 
author  to  author,  these  gentlemen  seeming  to  have  for- 
gotten that  they  are  of  the  medical  and  not  of  the  clerical 
staff.  Such  hypocritical  sermonizing  will  certainly  con- 
vert no  one.  As  long  as  there  are  lovers  there  will  be 
excesses  in  the  estimation  of  the  authors,  but  not  re- 
sented by  nature.  Nature  punishes  only  such  as  act 
contrary  to  her  laws  by  employing  various  means  to 


FORMS  OF   IMPOTENCE.  143 

rouse  desires  and  to  irritate  the  strained  nerves  to  im- 
moderate activity. 

Since  virility  is  not  of  the  same  degree  in  all  indi- 
viduals, the  limit  between  normal  use  and  excess  in  them 
must  also  be  different.  Without  regard  to  age  or  the 
state  of  health,  the  disposition  at  the  time  being  is  of  ex- 
traordinary influence.  That  which  was  moderate  indul- 
gence ten  years  ago  may  be  excessive  to-day ;  and  even 
Avhat  might  have  been  accomplished  easily  and  without 
fatigue  a  few  days  or  a  few  weeks  ago  may  be  hurtful 
now.  So  also  what  may  have  seemed  quite  normal  with 
one  woman  may  have  to  be  considered  as  a  decided 
excess  if  committed  with  another  woman. 

Inquiring  into  the  reasons  that  induce  a  man  to  commit 
sexual  excesses,  we  cannot,  after  what  has  been  said 
above,  accuse  age,  amativeness,  temperament,  etc.,  as 
Lallemand  does ;  for  such  manifestations  of  the  sexual 
instinct  as  are  produced  by  youth,  temperament,  or  sen- 
suousness  cannot  be  called  excesses.  The  inducements 
to  excess  in  venery  are  only  few  ;  in  the  order  of  their 
frequency  they  are :  masculine  vanity,  love,  sensual 
women,  different  conditions  of  irritability  of  the  sexual 
organs,  and  hyperesthesia  of  the  sexual  centra,  which 
may  pass  into  maniacal  conditions  and  become  a  veri- 
table satyriasis  with  priapismus. 

Masculine  vanity  is  the  commonest  cause  of  sexual 
excesses,  as  Lallemand l  has  already  observed.  In  wed- 
lock and  out  of  wedlock  the  man  feels  the  desire  to 
impress  the  woman  with  his  power.  He  starts  from  a 
principle  that  is  correct  in  itself,  but  he  very  often  carries 
it  out  in  a  faulty  manner.  Over-exertion  in  sexual  mat- 

1  Op.  cit,  p.  614. 


144  SEXUAL   IMI'OTIvNCK. 

ters  seldom  impresses  the  woman  favorably,  and  inevi- 
tably leads  to  humiliation ;  and  besides,  the  descent  from 
the  pedestal  of  a  hero  often  leads  to  dissatisfaction  in 
marriage,  and  may  induce  the  wife  to  seek  elsewhere 
that  which  she  has  learned  to  like  and  which  her  hus- 
band can  afford  her  no  longer. 

Love  may  sometimes  give  occasion  to  excess.  The 
desire  to  unite  with  the  object  of  love  as  often  as  possi- 
ble may  overtax  the  sexual  organs.  Love  is  decidedly  a 
powerful  stimulus,  but,  like  all  stimuli,  it  loses  its  power 
in  time.  Love  may  have  lost  its  stimulus,  but  may  still 
live  if  the  cause  lies  only  in  the  giving  way  of  virility. 
When  love,  however,  has  lost  its  stimulating  power, 
although  the  man  has  retained  his  vigor,  then  love  has 
simply  ceased  to  be  love. 

Voluptuous  women  may  now  and  then  be  the  cause 
of  sexual  excess,  but  it  must  be  said  that  in  general  over- 
sensual  women  are  the  exception,  and  novels  and  anec- 
dotes know  more  about  them  than  does  actual  life. 
Almost  without  exception,  woman  grows  unduly  sensual 
only  in  commerce  with  sensual  men  ;  but  if  once  she  is 
so,  then  woe  to  the  man  whom  she  holds  under  her 
sway,  if  he  has  not  the  courage  to  wish  her  good-by  in 
time. 

Occasionally  skin-diseases  about  the  genitals  cause  too 
frequent  erections  by  external  irritation.  If  we  except 
gonorrhea  and  its  sequelae,  quite  as  unfrequently  there 
may  occur  irritation  of  the  verurnontanum  or  in  its 
vicinity,  causing  untimely  erections  and  thus  provoking 
excesses. 

Some  persons  have  naturally  the  disposition  to  love 
always  and  much ;  they  do  not  feel  happy  unless  they 
are  in  love,  and  when  they  are  they  commit  so-called 


FORMS  OF   IMPOTENCE.  145 

excesses,  which  in  reality  are  not  to  be  so  regarded,  but 
which  should  rather  be  considered  as  manifestations  of 
their  sexual  power.  Indeed,  we  see  that  such  fortu- 
nately disposed  natures  receive  no  harm  whatever  from 
these  apparent  love-extravagances,  as  they  endure  men- 
tal and  physical  exertions  exceedingly  well.  Such  na- 
tures are  oftener  met  with  in  southern  countries  than 
in  northern,  oftener  belonging  to  the  better  educated 
classes  than  to  the  uncultivated.  They  are  mostly  of  a 
temperament  easily  roused,  generally  superficial,  and  in 
common  life  are  called  light-minded  people,  but  some- 
times deserve  a  better  name,  since  they  accept  life  as  it 
is.  As  a  rule,  puberty  shows  itself  in  such  persons  very 
early,  long  before  it  appears  in  other  individuals  of 
the  same  nationality.  Mantegazza1  says,  "To  precocious 
puberty  correspond  luxury,  polygamy,  and  libertinage." 
The  coincidence  of  early  puberty  and  excesses  in  south- 
ern nations,  may  find  its  explanation  in  the  fact  that 
persons  entering  upon  the  possession  of  their  sexual 
power  before  they  possess  full  responsibility  are  more 
apt  to  commit  sexual  extravagances. 

Again,  ubtnidtnice  of  power  will  be  sure  to  lead  to  ex- 
rrx.sr.s-,  as  authors  understand  them ;  but  these,  in  my 
opinion,  are  not  excesses  so  long  as  the  right  proportion 
with  the  force  is  maintained.  Decidedly  enviable  are 
those  so  fortunately  gifted  by  nature,  whom  we  might 
call  with  Mantegazza2  "  grandi  amatori"  (great  lovers), 
and  of  whom  he  says,  "  The  great  lovers  are  frequently 
weary,  but  in  their  weariness  there  is  not  a  shadow  of 
ennui." 


1  Gli  amori  degli  uomini,  vol.  ii.  p.  233. 
1  Fisiologia  deiramore.     Milano,  1882,  p.  383. 
10 


146  SEXUAL   IMPOTENCE. 

Excesses  in  venery  arc  generally  committed  by  IIM-II 
of  a  noble  character,  who  subordinate  hygienic  consid- 
erations to  the  pleasure  of  sharing  the  highest  delight 
\\illi  a  beloved  creature.  Hence  it  is  generally  genial 
natures  endowed  with  artistic  talents  that  worship  sen- 
sual pleasures  and  often  fall  a  victim  to  them  ;  whilst 
egotistical  and  mean  natures  calculate  in  numbers  and 
are  stopped  in  love's  intoxication  by  the  thought,  "  That 
might  hurt  me."  It  is,  however,  very  strange  that  those 
individuals  that  take  so  little  care  for  the  preservation  of 
their  virility  are  often  the  very  ones  who  keep  it  until  an 
advanced  age,  whilst  those  who  have  always  husbanded 
their  power  so  economically  often  lose  it  prematurely. 
The  force  of  habit  plays  here  an  imporlant  role.  Some 
descend  from  much  to  little,  and  others  from  little  to 
naught. 

I  beg  leave  here  to  advance  an  opinion  which  is  in 
opposition  to  the  views  of  most  authors, — viz.,  a  strong 
and  healthy  man  may,  by  means  of  reasonably  active 
gymnastics  of  his  sexual  power,  increase  it  considerably 
without  damaging  his  health,  since  a  vigorous  metabolism 
is  capable  of  rapidly  replacing  all  such  losses.  I  should 
hesitate  to  express  this  opinion  in  a  book  subject  to  the 
chance  of  being  read  and  misunderstood  by  laymen ; 
but,  in  a  work  written  for  medical  men  exclusively,  I  feel 
it  my  duty  to  state  the  bare  facts  unadorned  as  expe- 
rience has  shown  them  to  me,  and  thereby  obtain  the 
result,  perhaps,  that  some  doubt  may  introduce  itself 
into  the  realm  of  common  petty  ideas  of  narrow 
minds. 

A  gland  that  has  seldom  been  excited  to  ordinary, 
and  never  to  energetic  activity,  will  never  yield  the  same 
quantity  of  secretion  as  one  that  is  never  overtaxed,  but 


FORMS  OF  IMPOTENCE.  147 

is  roused  frequently  arid  vigorously.  Exactly  the  same 
may  be  said  of  the  muscles  of  the  apparatus  in  question, 
which,  by  reasonable  use,  may  be  strengthened  and 
rendered  capable  of  performing  their  functions.  The 
glands  and  muscles  active  in  sexual  intercourse,  all  of 
which  are  secreting  or  at  work  through  the  influence  of 
the  nerves  in  action,  are  subject  to  the  same  laws  as  the 
nerves  themselves,  and  will  consequently  be  assisted 
in  their  secretion  and  strengthened  in  their  activity  by 
moderate  and  even  stronger  irritation,  though  they  would 
be  weakened  by  too  strong  an  irritation. 

It  is  certain  that  the  nervous  system  is  strengthened 
by  every  inducement  to  action  as  long  as  the  action  re- 
quired is  within  the  limits  of  performance  without  effort. 
Too  much,  however,  is  here  more  damaging  than  too 
little,  and  the  happy  mean  is  to  be  followed. 

Too  little  irritation  is  apt  to  render  the  nerves  and 
their  centers  inert  in  reaction  and  weak  in  functional 
power;  thus,  the  genital  glands  which  they  innervate 
will  be  made  indolent  in  secretion  and  the  muscles  of 
erection  weakened  and  stunted.  Again,  too  much  irri- 
tation affects  badly  the  co-operating  nerve-apparatus,  and 
causes  first  a  state  of  excitation  and  then  of  relaxation. 
This  is  the  reason  why  men  who  are  habitually  exces- 
sive in  venery  are  for  a  time  specially  powerful,  for  the 
sexual  nerves  are  in  a  state  of  excitement;  but  this 
condition  gradually  changes  into  a  state  of  weakness, 
which,  in  its  turn,  passes  over  into  a  state  of  paralysis  if 
rest  does  not  intervene  in  time.  "  Lasting  immoderate 
irritation  of  the  nerve,  without  a  time  of  rest  sufficient 
for  recuperation,  gives  rise  to  lassitude  at  first,  and  then 
leads  to  diminution  of  the  excitability  by  exhaustion  of 
the  nerve  ;  and  yet  the  nerves  are  possessed  of  extraor- 


148  SEXUAL  IMPOTENCE. 

dinary  endurance  with  respect  to  the  most  various  irri- 
tations." ' 

Decrease  of  the  sexual  power  is  for  one  who  com- 
mits excesses  in  venery  a  sign,  given  by  a  sometimes 
kind  nature,  that  it  is  time  to  retreat.  Unfortunately, 
this  sign,  though  noticed  by  most  offenders,  it  is  true,  is 
wrongly  interpreted,  and  may  even  cause  impatience  or 
anger.  A  struggle  against  nature  begins  ;  moral,  physi- 
cal, and  even  medicamental  excitants  are  brought  into 
service,  but  even  these  subsidiary  forces  leave  the  indi- 
vidual in  the  lurch,  as  the  combat  is  an  unequal  one, 
and  impotence  is  the  result. 

Now,  instead  of  looking  for  help,  the  impotent  man 
gives  way  to  the  general  belief  that  there  is  no  herb 
growing  for  impotence.  The  physician  often  supports 
this  belief  by  sending  the  unfortunate  patient  away  with 
a  few  well-meant  phrases  of  solace,  instead  of  proceed- 
ing first  to  a  correct  diagnosis  and  then  to  the  determi- 
nation of  the  appropriate  treatment.  Thus,  then,  the 
patient  is  generally  left  to  himself;  recourse  is  had  to 
new  and  stronger  excitants ;  he  torments  himself  to 
bring  about  coition  ;  these  fruitless  efforts  aggravate  the 
evil ;  they  dull  the  nerves  and  their  centers  more  and 
more,  until,  finally,  they  exhaust  them,  so  that  paralytic 
impotence  results. 

In  order  to  comprehend  the  pernicious  effect  of  ha- 
bitual excesses  in  venery,  we  must  first  of  all  consider 
more  closely  the  after-effect  of  the  sexual  act.  Ac- 
cording to  most  authors,  man,  after  copulation,  is  in  a 
state  of  exhaustion,  the  duration  of  which  varies  in  the 

1  Landois,  Lehrbuch  der  Physiologic.  Wien  und  Leipzig,  1893, 
p.  673. 


FORMS  OF  IMPOTENCE.  149 

opinion  of  these  authors.  Now,  generally  speaking,  this 
is  not  so.  A  robust  man  who  is  in  possession  of  his  full 
sexual  power  is,  after  coition,  not  exhausted  or  depressed 
at  all.  He  keeps  generally  perfectly  still,  because  the 
action  of  the  heart  and  of  the  lungs  has  been  accelerated 
and  must  now  be  moderated,  and  because  he  still  holds 
the  object  of  his  love  in  his  arms  and  ruminates  upon 
the  past  happiness.  Those  individuals  who  feel  ex- 
hausted after  copulation  had  better  not  commence  at  all, 
and  the  authors  who  uphold  the  idea  may  possibly  give 
expression  to  their  own  experience.  With  a  man  per- 
fectly vigorous  sexually  the  Latin  phrase,  "Lsete  venire 
Venus,  tristis  abire  solet,"  applies  only  to  the  same  ex- 
tent as  in  the  case  of  a  gourmand  who  enjoys  a  good 
appetite,  and  thus  regrets,  after  a  meal,  that  it  is  not 
to  commence.  The  discovery  made  by  Beard,  that  the 
pernicious  consequences  of  coition  often  do  not  show 
themselves  until  the  third  day,  must  be  characterized  as 
at  least  peculiar.  This  discovery  our  American  neuro- 
pathologist claims  to  have  made  on  a  patient  who  was 
unquestionably  neuropathic,  and,  moreover,  suffering 
from  spermatorrhea.  A  man  who  feels  the  effects  of 
copulation  three  days  afterward  ought  to  be  forbidden 
sexual  intercourse. 

Now,  although  I  deny  that  coition  must  of  necessity 
be  followed  by  a  .state  of  exhaustion,  yet  I  must  grant 
that  coition  implies  or  necessitates  the  spending  of  a  cer- 
tain amount  of  force.  In  the  first  instance  it  means  a 
bodily  exertion ;  secondly,  the  work  performed  by  the 
nerves  and  their  centers  is  considerable ;  and,  thirdly, 
on  the  part  of  the  male  the  loss  of  substance  must  be 
taken  into  account.  It  is  certainly  not  the  bodily  exer- 
tion that  causes  the  pernicious  consequences  of  immod- 


150  SEXUAL   IMPOTENCE. 

erate  copulation,  for  we  know  that  all  bodily  exertion  is 
rather  beneficial  to  the  health  of  man.  Is  it  the  in  nine 
effort  of  the  nervous  system,  or  is  it  the  excessively  giv;il 
loss  of  substance?  Certainly  neither  the  one  nor  the 
other  alone,  but  both  combined,  with  the  co-operation 
of  other  influences  about  which  we  cannot  yet  say  much. 

To  prove  that  the  excessive  loss  of  sperm  causes  the 
bad  effects  of  sexual  excesses,  a  comparison  of  these  effect  x 
on  the  two  sexes  has  often  been  made.  It  has  been  as- 
serted that  women  suffer  more  rarely  than  men  from 
the  evil  consequences  of  sexual  excess.  This  assertion 
is  not  in  accordance  with  daily  experience,  which  teaches 
us  that  sexual  excesses  have  on  women  a  more  serious 
and  more  lasting  effect  than  on  men.  We  need  only  to 
observe  very  young  married  couples.  The  recollection 
of  every  physician  will  show  him  the  pale  and  fatigued 
face  of  the  wife  beside  the  comparatively  fresh,  though 
somewhat  emaciated,  face  of  her  husband. 

Attention  must,  however,  be  called  to  the  fact  that 
women  very  soon  accustom  themselves  to  sexual  exer- 
tion, and  then  even  excesses  are  more  easily  endured  by 
them.  Besides,  if  the  woman  feels  a  disinclination  for 
a  man,  she  can,  without  participating  in  the  act,  simply 
endure  it.  If  disinclination  on  the  part  of  the  man  can 
cause  in  him  relative  impotence,  disinclination  expe- 
rienced by  the  woman  may  produce  a  .kind  of  frigidity,  so 
that  while  giving  herself  up  to  the  act  she  can  remain 
perfectly  indifferent.  Here  we  have,  then,  the  key  to 
the  assertion  of  some  men  who  declare  women  in  gen- 
eral to  be  sexually  greedy ;  whilst  others — especially 
scholars,  for  whom  the  ladies  have  often  no  liking — 
declare  them  cold  and  insensible. 

The  loss  of  substance  certainly  plays  a  role  of  some 


FORMS  OF  IMPOTENCE.  151 

importance,  and  it  is  not  only  the  circumstances  preced- 
ing and  accompanying  the  ejaculation,  and  certain  pro- 
cesses going  on  in  the  nervous  system  *  which  cause  the 
evil  effects  of  sexual  excesses.  This  may  be  understood 
when  we  consider  that  evil  consequences  of  a  greater 
magnitude  follow  the  loss  of  sperm  from  spermatorrhea 
than  from  sexual  excesses.  In  some  cases  of  sperma- 
torrhea of  a  high  degree  the  loss  of  semen  is  unattended 
with  consciousness,  and  we  can  hardly  imagine  any  in- 
fluence that  could  primarily  affect  the  nervous  system. 

Paget2  thinks  that  the  morbid  condition  in  the  nervous 
system,  and  more  especially  in  the  spinal  cord,  caused 
by  excessive  coition  is  analogous  to  the  condition  which 
is  observed  in  muscles  after  excessive  efforts.  The  com- 
parison between  muscle-atrophy  and  paraplegia  might 
be  very  instructive  if  sexual  excesses  ever  caused  para- 
plegia. 

In  this  comparison  by  Paget  of  muscle-action  and 
nerve-action  I  consider  only  the  following  observation 
correct,  in  which  he  says,  "  I  cannot  explain  to  myself 
why  excessive  coition  infallibly  causes  loss  of  sexual 
vigor  with  certain  persons,  while  the  same  excess  causes 
in  other  persons  no  manner  of  disturbance.  But  the 
same  different  effects  are  observed  in  respect  to  muscle- 
effort,  and  remain  also  without  explanation.  A  given 
amount  of  muscle-exertion  that  exhausts  one  individual 
and  leads  to  muscle-atrophy  develops  the  power  in 


1  Curschmann,  Die  functionellen  Storungen  der  mannlichen  Gen- 
italien.     Handbuch  der  speciellen  Pathologie  und  Therapie  vou 
Ziemssen,  Band  ix.,  Halfte  2,  p.  476. 

2  Acton,  Fonctions  et  desordres  des  organes  de  la  generation,  p. 
237. 


152  SEXUAL    IMPOTENT!!. 

another,  and  increases  the  capacity  and  vital  energy  of 
the  muscles  at  work." 

What  are  the  real  consequences  of  immoderate 
coition?  As  far  as  my  knowledge  reaches,  there  is  only 
one  really  serious  effect,  but  that  brings  in  its  train  a 
series  of  other  evils :  it  is  sexual  impotence. 

No  one  doubts  that  excesses  in  venery  cause  impo- 
tence. Those  who  have  not  denied  themselves  the 
enjoyments  of  life  know  that  after  such  excesses  then- 
occurs  a  time  during  which  desires  lie  dormant.  With 
weaker  natures  such  a  time  follows  sometimes  after 
very  few  excesses;  even  after  a  single  night  of  revel- 
ling, there  ensues  a  longer  or  shorter  period  when 
coition  would  be  an  impossibility.  This  condition  can- 
not be  called  impotence,  for  it  is  physiological,  similar 
to  the  state  of  fatigue,  and  is  caused  by  the  spending 
of  the  provision  of  sperm  and  the  exhaustion  of  the 
sexual  nerves  and  their  centers.  With  sexually  wc;ik 
men  this  state  lasts  longer  than  with  stronger  ones.  It 
will  last  longer  after  repeated  excesses,  and  these  pauses 
growing  ever  longer  pass  sooner  or  later  into  a  perma- 
nent inability,  which  we  justly  call  impotence.  These 
pauses  are  certainly  a  wise  provision  of  nature ;  they 
are,  in  a  measure,  bars  placed  in  front  of  the  impetuosity 
of  youth.  Without  these  bars  there  would  be  many 
move  impotent  persons  than  there  are. 

After  sexual  excesses  the  spinal  cord  is  no  doubt  in 
a  state  of  hyperemia.  Hence  the  state  of  irritation  in 
the  centers  of  erection  that  continues  after  the  excess, 
and  the  fatigue  of  the  overtaxed  nerve-substance  which 
is  plainly  seen  after  the  cessation  of  the  hyperemia. 
After  many  such  states  of  lassitude,  which  may  pass 
away  more  or  less  rapidly,  there  ensues  a  state  of  ex- 


FORMS  OF  IMPOTENCE.  153 

haustion  which  may  be  permanent.  This  constitutes 
impotence.  Impotence  following  sexual  excesses  is  in 
the  great  majority  of  cases  a  state  of  exhaustion  of  the 
nerves  and  nerve-centers  concerned, — a  kind  of  sexual 
neurasthenia  of  different  grades. 

In  the  main,  excesses  in  venery  cause  only  sexual 
neurasthenia ;  whilst  onanism  causes,  besides  sexual 
neurasthenia,  derangement  of  the  organs  of  secretion, 
and  especially  of  those  of  ejaculation.  From  this  arise 
primary  morbid  pollutions,  which  finally  produce  impo- 
tence. The  same  is  true  of  continence,  but  in  rare 
cases  only. 

Neurasthenia  sexualis  arising  from  sexual  excesses 
shows,  like  every  other  form  of  neurasthenia,  quite  pe- 
culiar phenomena,  and  its  symptomatology  resembles 
that  of  general  neurasthenia  in  many  points.  As  already 
stated,  there  are  to  be  seen  signs  of  exhaustion  of  differ- 
ent grades.  Sometimes  the  desires  of  the  patient  are  in 
marked  contrast  with  his  force.  At  times  positive  saty- 
riasis  may  be  observed  in  completely  impotent  men. 
Such  individuals  practise  mental  and  actual  onanism,  as 
they  are  no  longer  capable  of  performing  the  sexual  acts 
so  ardently  wished  for. 

Again,  the  sexual  apparatus  may  still  be  comparatively 
apt  in  function,  but  the  subject  is  nevertheless  impotent 
because  of  a  sexual  frigidity  which  is  not  an  unusual 
consequence  of  sexual  excesses.  The  feeling  of  satiety 
which  is  observable  after  nearly  every  sexual  excess, 
but  which  generally  disappears  rapidly,  becomes  per- 
manent in  some  cases,  and  the  individual,  who  still  has 
erections  now  and  then,  is  nevertheless  impotent,  as  he 
feels  an  apathy  toward  the  female  sex.  This  state,  it 
is  true,  is  commonly  observed  only  in  persons  who  have 


154  SMXUAL   IMPOTENCE. 

never  had  a  well-developed  sexual  instinct,  and  who,  in 
spite  of  this,  allowed  themselves  to  be  incited  to  excesses. 
The  same  state  may,  however,  appear  in  persons  of  a 
strongly  developed  sexual  impulse,  who  have  committed 
repeated  excesses  with  persons  whose  physical  qualities 
were  not  worth  such  an  effort.  Such  frigidity  is  par- 
ticularly noticed  after  manifestations  of  power  performed 
with  a  view  to  pecuniary  gain,  and  in  husbands  who 
sometimes  perform  their  conjugal  duties  for  years,  and 
conscientiously,  but  with  reluctance. 

Another  form  of  impotence  is  noticed  in  the  track  of 
excesses  in  venery  continued  for  years,  in  which  the 
sexual  organs  may  continue  to  be  capable  of  function. 
After  years  of  excesses  there  arises  a  state  of  satiety  for 
ordinary  sexual  pleasures,  a  torpor  of  the  sexual  emo- 
tions for  normal  and  natural  satisfaction.  A  perverse 
sexual  sensation  develops  itself  quite  gradually.  The  pa- 
tient is  incapable  of  performing  the  sexual  act  in  a  natural 
manner,  but  can  still  indulge  in  pederasty  or  other  way- 
ward acts  to  satisfy  his  perverse  lusts.  This  form  of 
impotence  in  consequence  of  sexual  excesses  is  oftehest 
observed  in  old  men,  the  majority  of  whom  have  some 
psychical  affection.  All  the  perverse  actions  of  sick  and 
also  of  insane  persons  are  merely  an  extraordinary  aug- 
mentation of  normal  phenomena,  emotions,  and  acts 
arising  from  psychological  and  physiological  origin ;  and 
similarly  we  can  trace,  in  the  forms  of  perverse  feeling, 
a  highly  abnormal  exaggeration  of  phenomena  observed 
in  healthy  persons. 

It  is  generally  known,  though  not  so  generally  ad- 
mitted, that  the  original  taste  in  sexual  matters  undergoes 
manifold  changes  with  increasing  age  and  after  numer- 
ous sexual  enjoyments.  As  there  is  a  great  difference 


FORMS  OF  IMPOTENCE.  155 

in  the  individuals,  it  is  impossible  to  establish  a  general 
rule  or  law,  and  I  shall  therefore  attempt  only  to  rep- 
resent the  process  in  the  manner  in  which  it  generally 
presents  itself  for  observation. 

In  the  first  place,  we  must  entirely  exclude  the  early 
years  of  ardent  desires  that  come  before  completely  de- 
veloped sexual  maturity.  These  are  the  years  of  sexual 
blockheadedness  and  awkwardness ;  the  individual  is 
without  taste,  and  not  at  all  particular  in  the  choice  of 
altars  on  which  to  make  his  sacrifices  to  Venus,  although 
he  dreams  of  ideals.  When,  however,  that  sexual 
bulimia,  as  we  may  call  it,  is  over,  taste  appears,  and 
the  individual  grows  particular  wdthin  the  limits  of  his 
taste.  This  taste  is  good  or  bad  in  the  opinion  of  his 
fellow-men,  but,  judged  from  his  own  stand-point,  it  is 
always  good.  The  taste  remains  then  generally  settled 
during  the  years  of  the  greatest  virile  power ;  but  when 
riper  manhood  approaches  it  begins  to  deteriorate.  The 
individual  grows  less  and  less  particular,  and  will  carry 
on  commerce  with  persons  he  would  formerly  have 
rejected  with  contempt.  This  corruption  of  taste  is  the 
reason  why  elderly  gentlemen  often  associate,  for  the 
time  being,  with  slovenly  and  unattractive  servant-girls. 
Closer  examination  will  prove  the  error  of  the  generally 
accepted  opinion  that  elderly  gentlemen  are  dainty  in 
their  choice,  and  that  only  the  want  of  a  better  chance 
can  make  them  less  particular.  Of  course,  due  consid- 
eration is  to  be  paid  to  the  role  played  in  this  respect  by 
education,  the  different  conditions  of  wealth,  rank,  and 
other  circumstances. 

The  abnormal  exaggeration  of  this  physiological  deg- 
radation, as  I  would  call  it,  in  the  sexual  taste,  is  often 
the  origin  of  perverse  sexual  sensation.  The  class  of 


|;,(i  SKXIAL    I.MI'UTK.NCK. 

individuals  wlio  have  tlius  become  perverse  comprises 
all  those  who,  after  a  long,  honest,  and  exemplary  exist- 
ence, come,  in  their  old  age,  into  conflict  with  the  law, 
as  pederasts,  exhibitionists,  or  ravishers. 

In  a  few  isolated  cases,  and  especially  with  sexually 
weak  individuals,  continued  excesses  lead  to  paralytic 
impotence,  as  already  stated.  This  is  equivalent  to 
complete  paralysis  of  the  sexual  nerves  and  their  cen- 
ters,— a  condition  which  certainly  occurs  very  seldom  in 
young  persons. 

Besides  the  states  already  described,  excessive  venery 
causes  transient  feebleness  in  the  entire  body  and  dis- 
turbances in  the  functions  of  single  organs.  After  a 
real  excess  in  venery  the  individual  feels  weary  and  ex- 
hausted, may  be  nervously  agitated  for  a  time,  and  may 
be  visited  by  vertigo  and  fainting  fits.  However,  all 
these  symptoms  generally  vanish  after  a  few  hours' 
undisturbed  sleep  following  a  strengthening  meal.  The 
individual  will  experience  no  further  consequences. 

I  never  saw  or  heard  of  ejaculations  mixed  with  blood ; 
although  Lausac l  has  recently  asserted  that  the  causes 
of  it  may  be  urethritis,  prostatitis,  epididymitis,  also  sex- 
ual excesses,  or  long  continence.  I  believe,  however,  that 
this  is  probably  of  exceedingly  rare  occurrence,  and 
will  hardly  appear  in  normal  individuals.  I  do  not  think 
that  gonorrhea  can  arise  from  protracted  coitus  or  sexual 
excesses,  as  Lallemand  seems  to  believe,2  if  the  subject 
is  in  perfect  health.  Nor  can  I  believe  that  sexual  ex- 


1  Untersuchungen  iiber  die  Hamatospermie.     Med.-chir.  Rund- 
schau.    Wien,  1888,  Heft  3,  p.  95. 

2  Des  pertes  serninales.     Paris,  1836,  tome  i.  p.  586. 


FORMS   OF  IMPOTENCE.  157 

cesses  can  cause  degeneration,  suppuration,  or  induration 
of  the  cerebellum.1 

Some  individuals  committing  frequent  excesses  in 
venery,  if  they  are  strong,  accustom  their  nature  to  these 
excesses  after  a  time.  Such  wanton  persons  may  com- 
mit great  excesses  almost  with  impunity  for  a  long  time. 
They  consider  themselves  heroes  in  sexual  matters  ;  but, 
nevertheless,  they  steadily  lose  flesh  in  spite  of  an  ap- 
petite that  may  be  quite  excellent.  Exceptionally  it  is 
noticed  that  sexual  excesses  seem  to  favor  the  develop- 
ment of  obesity.  I  have  known  a  man,  thirty-two  years 
old,  who  was  continually  losing  weight  during  continence 
and  a  state  of  good  health,  whilst  he  gained  in  weight 
when  he  was  doing  his  utmost  sexually. 

Sooner  or  later  the  sexual  power  is  sure  to  diminish 
noticeably  after  sexual  excesses,  even  with  individuals  of 
great  resisting  power,  and  temporary  impotence  will  then 
for  a  time  prevent  further  excesses.  This  dallying  with 
one's  sexual  power  I  have  observed  frequently,  and  have 
received  many  reports  of  the  same  kind  from  my  patients. 

I  never  saw  the  fearful  consequences  of  excesses  as 
they  are  described  in  books.  I  never  saw  one  case  of 
frequent  pollutions  or  spermatorrhea  caused  by  excess 
in  venery.  Considering  that  I  have  observed  a  great 
number  of  such  wanton  persons,  and  a  still  greater 
number  of  patients  suffering  from  spermatorrhea,  I  may 
be  justified  in  the  assertion  that  immoderate  coition 
without  onanism  cannot  cause  spermatorrhea.  Among 
Oriental  nations,  where  polygamy  is  the  rule,  and  occa- 
sions for  excesses  are  constantly  presented,  premature 

1  Black,  On  the  Functional  Diseases  of  the  Urinary  and  Reproduc- 
tive Organs.  London,  1875,  p.  112. 


158  s i:\r.\i,  IMPOTENCE. 

impotence  is  often  noticed,  hut  s|iennalorrlieu  very  sel- 
dom. Abnormal  pollutions  ;nnl  s|terin;itorrlie;i  arise 
now  and  again  in  the  train  of  impotence,  but  never 
directly  after excesses  in  venery.  however  long  these  may 
have  been  practised.  This  is  the  chief  difference  between 
the  effects  of  onanism  and  those  of  excessive  coition. 

The  consequence  of  excess  in  venery  is  always  and 
without  exception  impotence,  this  impotence  putting  a 
stop  to  further  excess. 

It  is  difficult  to  obtain  a  clear  idea  of  the  manner  of 
action  of  the  pernicious  effects  of  continued  sexual  ex- 
cesses, because  we  are  denied  the  possibility  of  watch- 
ing the  pathological  changes  caused  by  these  excesses. 
Virility  enfeebled  by  habitual  excess  does  not  make  itself 
felt  by  any  kind  of  trouble  in  the  sexual  organs,  and 
sometimes,  though  no  change  in  them  is  visible,  the 
individual  is  impotent. 

Although  the  rest  of  the  body  may  be  quite  normal  in 
its  functions,  we  see  that  some,  though  not  all,  persons 
suffering  from  sexual  debility  lose  weight.  This  degen- 
eration of  the  forces,  this  general  sinking,  can  be  explained 
only  by  the  injurious  effect  on  the  mind  produced  by 
consciousness  of  impotence;  whilst  the  paralysis  of  I  he 
sexual  nerves  can  be  attributed  only  to  the  consumption 
of  the  nerve-power.  However,  we  cannot  say  what  this 
consumption  really  means.  Whilst  the  question  has 
scarcely  been  studied  at  all,  and  lies  in  great  darkness 
before  us,  we  can  only  say,  Continued  excesses  in  vcnn-i/ 
lead  sooner  or  later  to  impotence,  with  a  rapidity  varying  in 
proportion  with  individual  differences  ;  and  impotence  brin</x 
very  often  in  its  train  other  unpleasant  consequences.  If 
some  authors  state  that  there  are  men  who  commit  ex- 
cesses in  venery  with  impunity,  we  must  remember  that 


FORMS  OF  IMPOTENCE.  159 

what  these  men  have  committed  were  not  excesses  in 
the  true  sense  of  the  word. 

» 

It  is  amusing  to  read  the  statement  that  some  cases 
have  been  noticed  where  single  excesses  in  venery  have 
caused  death.  No  doubt  long-continued  sexual  excesses 
may  cause  temporary  disturbances  in  the  functions  of 
other  bodily  organs,  but  permanent  derangement  cer- 
tainly can  occur  only  in  weak  and  sickly  individuals, 
since  the  sexual  organs  refuse  obedience  in  proper  time. 

The  assumption  that  sexual  excesses  may  directly 
cause  atrophy  of  the  testicles,  for  example,  is  certainly 
erroneous,  since  impotence  is  always  primary ;  while 
atrophy  of  the  testicles  is  only  secondary  in  consequence 
of  impotence. 

It  used  to  be  the  custom  to  impute  everything  to 
sexual  excess :  a  death  whose  cause  was  not  clearly 
discernible  was  attributed  to  sexual  excesses ;  if  some 
one  became  insane,  sexual  excesses  were  blamed  for  it. 
Even  in  case  the  father  and  mother  had  been  insane, 
inheritance  had  nothing  to  do  with  it.  If  a  man  died 
suddenly  in  an  ill-famed  house,  sexual  excesses  were 
accused,  and  one  forgot  that  the  man  had  quite  as  good 
a  chance  of  dying  suddenly  in  his  conjugal  bed,  though 
he  rarely  may  have  made  the  proper  use  of  his  conjugal 
rights.  If  any  one  should  wish  to  convince  himself  of 
the  exaggeration  that  is  going  on  in  these  matters  even 
nowadays,  he  has  only  to  take  up  a  modern  book,  such 
as  Bourgois,1  for  instance,  where  he  can  read  literally, 
"  Dissolute  persons  are  so  frequently  subject  to  spinal 
diseases  that  the  special  name  of  dorsal  consumption  or 

1  Les  passions  dans  leurs  rapports  avec  la  sante  et  les  maladies. 
Paris,  1877,  p.  144. 


100  SKXUAL    IMPOTEXCK. 

phlliisis,  tabes  dorsalis,  has  been  given  to  them  when 
they  originate  from  sexual  excesses."  Dr.  J.  A.  Spalding, 
of  Portland,  Maine,  goes  even  further,  and  relates  tlie 
history  of  a  group  of  four  cases  of  optic  atrophy  following 
sexual  excess.  All  four  subjects  gradually  lost  useful 
vision  in  spite  of  treatment,  though  they  did  not  become 
totally  blind.  As  no  other  mortal  ever  had  the  chance 
to  observe  such  consequences  of  sexual  excesses,  and 
Dr.  Spalding,  on  the  contrary,  found  four  such  phenome- 
nal cases,  we  have  to  look  toward  the  Portland  climate 
or  imagination  for  an  explanation. 

In  no  other  disease  has  cause  so  frequently  been  mis- 
taken for  effect,  and  vice  versa.  Authors  too  often  ascribe 
many  pathological  states  to  sexual  excess,  without  no- 
ticing that  these  morbid  states,  together  with  their  sup- 
posed cause,  have  a  common  and  deeper  origin  in  an 
inherited  pathological  predisposition.  Thus,  then,  the 
effect  was  mistaken  for  the  cause. 

Generally  speaking,  real  excess  in  venery  seldom 
occurs,  and  is  not  often  the  cause  of  impotence  or  of  a 
general  physical  degeneration.  In  case  extraneous  cir- 
cumstances do  not  prevent  an  individual  from  accom- 
plishing his  own  ruin  by  sexual  indulgence,  nature,  as  a 
rule,  will  refuse  him  the  means  for  continuing  his  ex- 
cesses. Not  all  women  will  consent  to  excesses ;  again, 
the  individual,  if  somewhat  energetic,  may  restrain  him- 
self from  further  excesses. 

We  shall  meet  with  altogether  different  conditions 
when  we  make  excessive  onanism  the  subject  of  our 
discussion.  If  onanisrn  causes  degradation  of  the  physi- 
cal force  and  impotence  much  more  frequently  than 
excesses  in  venery,  we  find  the  explanation  in  this  dif- 
ference of  all  the  conditions. 


FORMS  OF  IMPOTENCE.  161 

It  is  only  an  exception  when  excesses  in  venery  can 
be  practised  before  the  individual  has  become  pubescent, 
for  he  generally  lacks  the  means  and  occasion  therefor ; 
onanism,  on  the  contrary,  may  be  practised  by  an  unde- 
veloped child,  as,  unfortunately,  is  frequently  the  case. 
Of  course,  every  sexual  excess  committed  by  an  indi- 
vidual before  puberty  is  ever  so  much  more  far-reaching 
in  its  consequences. 

Nature  is  seldom  able  to  hinder  the  onanist  in  his 
destructive  work  until  it  is  too  late.  The  onanist  wants 
no  erection :  he  can  without  it  bring  about  orgasm  and 
ejaculation.  The  onanist  need  not  wait  for  time  of 
leisure  or  for  a  special  place  or  occasion.  He  can  sat- 
isfy his  desire  in  bed  under  the  warm  covers,  almost 
under  the  eyes  of  his  parents  and  teachers,  in  the 
closet,  in  any  dark  corner.  Some  have  acquired  such 
dexterity  that  they  can  ever  add  new  injury  to  the 
weakened  sexual  organs,  which  are  almost  continuously 
in  a  state  of  irritation,  by  clever  manipulations  of  the 
penis  by  the  hand  introduced  into  the  pocket  of  the 
trousers.  This  can  be  done  at  school,  at  church,  at  the 
theatre,  at  balls  and  other  entertainments,  or  during  a 
walk  in  the  street  or  a  ride  in  a  carriage. 

The  recovery  from  this  condition  is  more  difficult  to 
accomplish,  and  the  ability  to  desist  from  further  injuring 
the  sexual  power  is  more  difficult  to  acquire,  in  this  case 
.than  in  the  case  of  excessive  venery.  The  individual  is 
not  able  to  avoid  seizing  the  opportunity  to  practise  his 
vice.  It  often  takes  a  long  time  for  the  onanist  to  get 
a  clear  understanding  of  the  evil  consequences  of  his 
actions ;  but  when  he  does  discover  his  error,  a  fearful 
struggle  arises  between  the  pernicious,  almost  over- 
powering habit  and  the  enfeebled  juvenile,  who  may  be 

11 


162  SEXUAL   IMPOTENCE. 

a  mere  child.  This  struggle  is  so  hard  and  dreadful  that 
even  a  vigorous  and  energetic  man  might  succumb. 

There  is  yet  a  weighty  circumstance  that  renders  ex- 
cesses in  onanism  far  more  fatal  than  excesses  in  venery. 
The  one  who  commits  excesses  in  venery  is  ever  enam- 
ored, feels  seldom  any  remorse  about  the  excess  he  has 
committed,  but  is  rather  inclined  to  look  upon  it  as  a 
triumph  of  his  irresistibleness  and  power.  He  is  satis- 
fied with  himself,  and  draws  immeasurable  joy  from  the 
inexhaustible  treasury  of  love.  He  is  most  of  the  time 
happy,  and  his  joyous  mood  contributes  largely  toward 
the  preservation  of  a  healthy  condition  of  his  body.  The 
reverse  of  this  is  the  case  with  the  onanist :  he  is  always 
in  conflict  and  exceedingly  dissatisfied  with  himself;  he 
is  ashamed  of  his  doings,  and  regrets  to  commit  what 
is  commonly  called  a  "  vice."  Hence  the  onanist  is  ill- 
humored  and  melancholic,  this  state  of  the  mind  having 
an  influence  which  almost  without  exception  produces 
an  injurious  effect  on  the  functions  of  nearly  all  the 
bodily  organs. 

Finally,  it  must  be  stated  that  it  is  not  at  all  settled 
whether  coition  and  masturbation  are  equivalent  acts. 
I  doubt  it  very  much,  because  I  know  that  with  individ- 
uals accustomed  to  excess  in  venery  the  commission  of  a 
single  act  of  onanism  leaves  them  in  a  weaker  and  more 
dejected  state  than  a  great  excess  in  copulation.  I  think 
that,  after  all,  the  circumstances  preceding  and  accom- 
panying ejaculation,  and,  most  of  all,  certain  processes  in 
the  nervous  system,  must  be  of  more  consequence  in 
onanism  than  in  copulation,  or,  that  these  "  circumstances 
and  processes"  require  a  greater  effort  to  be  brought  about 
by  onanism  than  by  coition,  and  consequently  produce 
greater  fatigue. 


FORMS  OP  IMPOTENCE.  163 

Every  medical  man  who  thinks  about  this  matter  must 
ask  himself  whether  those  authors  are  right  who  call 
onanism  a  vice.  I  do  not  think  they  are  ;  for  if  we  take 
into  consideration  the  circumstances  under  which  one 
falls  a  prey  to  onanism,  and,  moreover,  the  almost  in- 
surmountable difficulties  encountered  in  resisting  or 
overcoming  the  bad  habit,  we  unquestionably  must  come 
to  the  conclusion  that  onanism  should  with  more  justice 
be  called  a  disease.  In  the  same  manner  in  which  one 
may  fall  sick  without  any  fault  of  his,  he  may  fall  into 
the  grasp  of  onanism  and  be  unable  to  tear  himself 
away  even  with  the  greatest  effort. 

The  most  common  form  of  onanism  consists  in  moving 
with  IIHI/IH  propria  the  prepuce  backward  and  fonvard 
over  the  glans  until  ejaculation  is  obtained.  Sometimes 
the  onanist  produces  friction  of  the  prepuce  against  an- 
other object,  as,  for  instance,  by  lying  on  his  stomach  and 
rubbing  against  that  upon  which  he  rests,  thus  causing 
the  prepuce  to  move  over  the  glans;  less  frequently 
there  is  mutual  onanism  practised  between  twro  men. 
This  kind  of  onanism  occurs  most  frequently  among  per- 
sons affected  with  perverse  sexual  feelings,  but  who  have 
not  yet  sunk  to  pederasty.  Still  less  frequently  there  is 
mutual  onanism  between  man  and  woman  ;  yet  it  occurs 
'  often  enough,  and-  seems  to  become  a  regular  expedient 
in  matrimony  in  some  countries,  whereby  the  increase 
of  the  family  is  avoided.  Lingua  et  labia  are  then  often 
used  in  the  place  of  the  hands. 

Onanism  as  a  manner  of  satisfying  the  sexual  instinct 
is  very  widely  spread.  It  is  practised  by  almost  every 
young  man  when  he  becomes  pubescent,  so  that  one 
might  be  tempted  to  look  upon  onanism  as  a  phys- 
iological act ;  and  this  so  much  the  more  when  we 


KM  SKXI'AI,    IMI'OTKXCK. 

reali/e  liow  eagerly  monkeys  and  other  uniinals  prac- 
tise  it. 

Onanism  is  not  without  its  vindicators ;  only  they 
have  not  the  courage  to  speak  aloud  and  publicly  in 
behalf  of  their  belief.  In  a  small  circle  of  pupils  I 
once  heard  a  very  popular  professor  say  that  onanism 
moderately  practised  has  its  advantages,  particularly  for 
students,  as  money  and  valuable  time  are  saved,  all  un- 
pleasant connections  and  obligations  are  avoided,  no  one 
is  made  unhappy,  and  there  is  no  danger  of  contagious 
diseases.  If  considered  from  an  egotistic  stand-point, 
these  reasons  might  be  correct,  if  only  the  onauist  wen- 
capable  of  keeping  within  moderate  limits  ;  but  it  is  this 
excessive  onanism  that  renders  it  so  particularly  hurtful. 
The  onanist's  resolutions  of  restraint  may  be  compared 
to  the  "  serments  d'ivrognc."  Just  as  the  drunkard,  sit- 
ting with  the  last  of  the  number  of  glasses  that  he  vowed 
should  not  be  exceeded,  continues  to  allow  himself  just 
one  more,  "always  the  last,"  so  the  onanist  bargains 
with  himself,  and  his  "last  time"  becomes  centuple,  in 
spite  of  his  vows,  oaths,  and  promises. 

Although  we  have  really  to  deal  with  the  bare  facts 
only,  we  feel  interested  in  the  causes  of  this  universal 
practice  of  onanism,  because,  while  obtaining  a  knowledge 
of  the  cause,  we  may  get  a  knowledge  of  the  remedy. 

There  is  no  doubt  that  onanism  is  of  very  old  standing, 
perhaps  as  old  as  the  human  race.  Over  the  whole  ex- 
tent of  human  history  there  is  no  lack  of  statements,  or 
at  least  hints,  about  onanism.  Hebrews,  Greeks,  Romans, 
all  were  acquainted  with  it.  It  may  be  quite  true  that 
in  olden  times  onanism  was  not  so  common,  but  civiliza- 
tion cannot  be  accountable  for  the  difference ;  for  in 
those  times  the  young  people  did  not  lead  sedentary 


FORMS  OF  IMPOTENCE.  165 

lives ;  it  was  easier  for  them  to  procure  natural  sexual 
gratification,  if  they  were  not  already  pederasts.  Peder- 
asty, however,  always  goes  side  by  side  with  onanism. 
Again,  the  intercourse  with  venal  women  was  not  danger- 
ous, because  there  was  no  syphilis  in  those  times. 

If  onanism  has  not  already  become  a  habit,  it  is  out 
of  the  question  as  long  as  the  sexual  instinct  can  be  sat- 
isfied in  the  only  natural  way,  in  the  arms  of  a  responsive 
woman.  This  is,  besides,  the  manner  more  in  accord- 
ance with  feelings  of  love  ;  it  is  the  more  pleasant,  the 
nobler  act.  When,  however,  this  mode  is  denied,  then 
with  virile  men  erections  occur,  and  from  the  temptation 
of  feeling  and  fumbling  about  the  genitals  there  is  no 
great,  distance  to  masturbation.  The  present  social  reg- 
ulations cause  ever  increasing  difficulties  in  the  obtaining 
of  a  wife,  and  we  should  not  be  surprised  to  learn  that 
onanism  is  really  much  more  common  at  the  present 
time  than  during  any  part  of  antiquity.  Onanism  is  not 
practised  by  the  monkey  when  living  in  liberty  where  he 
can  go  after  his  mate ;  nor  by  the  bull  nor  the  stallion 
that  has  enough  of  cows  or  mares  brought  to  him  ;  nor 
with  the  dog  not  led  with  a  line  by  his  master.  Apes  and 
other  animals  fall  into  onanism  only  when  proper  mates 
are  not  obtainable. 

There  are  many  writers  who  assert  that  the  cause  of 
the  wider  and  wider  spreading  of  onanism  is  to  be  found 
in  the  ever-increasing  corruption  of  morals,  or,  as  some 
like  to  consider,  identical  with  enlightenment.  General 
attention  has  been  directed  to  onanism  but  recently.  We 
will  grant  that  onanism  has  been  "  ever  spreading," 
though  there  is  no  proof  of  this,  but  we  must  repel  the  re- 
proach laid  at  the  door  of  modern  culture  or  civilization. 
Modern  culture  has  nothing  to. do  with  our  bad  social 


166  SEXUAL  IMPOTENCE. 

conditions  and  crazy  views  derived  from  medieval  limes 
which  are  the  chief  causes  of  onanism.  These  conditions 
and  views  came  down  to  us  from  the  time  of  the  greatest 
religious  intensity  ;  and  they  remain  in  force,  not  because 
of  our  modern  culture,  but  in  spite  of  it.  We  can  only 
hope  that  when  this  culture  becomes  common  property 
it  will  free  the  world  from  these  fetters  that  hinder  free 
action,  and  then  onanism  will  be  shown  its  proper  place. 
Certainly  it  cannot  be  denied  that  the  present  mode  of 
education  of  our  children  offers  many  moments  favorable 
to  onanism  ;  but  this  very  mode,  too,  is  an  inheritance 
from  the  dark  ages. 

Children  learn  onanism  mostly  through  seduction,  and, 
as  a  rule,  one  child  learns  it  from  another.  A  single  so- 
called  black  sheep  often  suffices  to  corrupt  all  the  others 
in  a  family,  institute,  school,  etc.,  whereby  the  frequency 
of  onanism  in  boys'  and  girls'  institutes  finds  an  easy 
explanation.  The  younger  a  child  is,  the  easier  it  is  to 
allure  it,  even  those  who  at  first  resist  seduction  finding 
later  on  a  taste  for  it.  It  occurs,  though  seldom,  that 
coarse,  uneducated  bad  adults,  even  teachers,  find  a 
pleasure  in  misleading  immature  children  to  onanism. 
In  the  literature  of  the  subject  \ve  read  of  cases  quite 
incredible.  Thus,  there  are  nurses  and  nursery-maids 
who  understand  how  to  quiet  screaming  children  by 
playing  with  and  sucking  the  child's  genitals.  It  is  to  be 
remarked  that  the  little  screamer  is  easily  and  quickly 
silenced,  but  thereby  a  state  of  irritation  in  the  sexual 
organs  is  caused,  and  the  child  induced  to  pull  and 
play  with  them,  and  finally  to  practise  real  onanism. 
This  is  the  more  injurious  the  younger  and  weaker  the 
child  is. 

Rarely,  unwise  parents,  in  their  anxiety  for  the  child, 


FORMS  OF  IMPOTENCE.  167 

clothe  their  warnings  in  such  awkward  language  that  it 
draws  the  child's  attention  to  sexual  matters. 

I  regret  to  be  obliged  here  to  add  that  occasionally 
tin'  xfiifly  of  certain  subjects  may  lead  to  onanism,  and, 
unfortunately,  it  is,  strange  to  say,  principally  the  in- 
struction in  a  subject  that  is  generally  thought  to  further 
morality.  In  the  sentences  and  passages  to  be  mem- 
orized words  are  used  which  quite  evidently  have  refer- 
ence to  sexual  matters.  Immature  children  are  served 
with  little  stories  of  the  most  piquant  contents,  which 
are  for  them  the  first  hints  to  sexual  things.  Dull  chil- 
dren think  no  more  about  them,  but  sprightly  and  in- 
tellectual children  will  ponder  over  these  legends.  Dried- 
up  old  pedagogues  are  not  aware  of  the  kind  of  thoughts 
that  present  themselves  to  the  child  when  meditating  on 
certain  stories.  Then,  again,  we  have  in  our  high-schools 
the  Latin  and  Greek  classics  with  their  often  vulgar  and 
blunt  language.  It  is  well  known  how  eagerly  and  as- 
siduously the  passages  of  an  erotic  tendency  are  read 
and  the  greatest  linguistic  difficulties  overcome,  even  if 
such  passages  are  skipped  by  the  professors. 

Withal,  however,  I  do  not  mean  to  say  that  a  youth 
should  be  brought  up  in  ignorance  of  all  sexual  things. 
I  do  think  that,  by  all  means,  a  child  has  the  right  to  be 
exempted  from  obscene  ideas  as  long  as  he  is  sexually 
unripe  and  his  nature  does  not  assert  itself.  However, 
when  puberty  has  arrived,  and  has  announced  its  pres- 
ence by  unmistakable  signs,  then  I  think  the  youth  should 
be  told  all  the  truth,  without  allowing  him  to  be  excited 
by  piquant  reading.  Youth  may  find  that  piquant  which 
leaves  a  man  perfectly  indifferent. 

What  are  we  to  say  or  to  think  of  a  medical  man  ad- 
vising mothers  to  endeavor  to  accustom  the  prepuce  of 


168  SEXUAL  IMPOTENCE. 

their  boys  to  remain  behind  the  corona  glandis?1  As 
fliis  can  be  accomplished  only  by  moving  the  prepuce 
repeatedly  back  over  the  glans,  such  mothers  would,  in 
plain  words,  masturbate  their  sons. 

Bad  example  is  the  most  frequent  cause  of  the  spread- 
ing of  onanism,  and  causes  the  greatest  injury,  because 
it  brings  under  the  sway  of  onanism  quite  immature 
children  who  up  to  that  time  did  not  feel  the  least 
movement  of  sexual  desires.  If  an  individual  is  not 
made  acquainted  with  onanism  by  comrades,  books,  or 
in  any  other  manner,  he  will  enter  the  age  of  puberty 
without  any  erotic  thought,  and  is  what  is  commonly 
termed  "  perfectly  innocent."  Notwithstanding  this  in- 
nocence, he  may,  in  one  moment,  be  overtaken  by 
onanism.  Sometimes  violent  erections  cause  him  to 
touch  the  genitals  with  his  hands,  and  thus  he  learns 
onanism  involuntarily  in  some  measure. 

Certain  movements,  performed  for  some  other  pur- 
pose, may  induce  onanism.  I  have  a  vivid  recollection 
of  the  history  of  a  youth  in  whom  I  was  quite  specially 
interested,  and  who  involuntarily  committed  an  act  of 
onanism.  He  was  an  industrious  student,  sixteen  years 
old.  During  his  studies  he  would  take  the  most  com- 
fortable positions,  and  thus,  lying  one  day  on  his  stomach 
over  three  chairs,  being  lost  in  thoughts  over  his  reading, 
he  swayed  his  body  to  and  fro,  without  noticing  the 
erection.  To  his  great  surprise  he  experienced  a  most 
pleasant  sensation  in  his  genitals,  quite  new  to  him,  but 
at  the  same  time  he  felt  a  strange  moisture.  It  was 
sperm,  which  he  first  took  for  urine.  By  such  ways 

1  A.  Theod.  Stamm,  Dr.  med.,  Dr.  phil.,  Die  Verhutung  der 
geschlechtlichen  Ansteckung.  Zurich,  1880,  p.  G3. 


FORMS  OF  IMPOTENCE.  169 

onanism  may  be  induced  in  quite  immature  individuals, 
or  individuals  who  have  scarcely  attained  puberty.  The 
incident  at  first  is  agreeable ;  its  dangers  are  either  un- 
known or  the  subjects  are  not  willing  to  believe  in  any. 
Youths,  however,  who  are  well  aware  that  the  evil  habit 
injures  them,  have  seldom  the  courage  to  rid  themselves 
of  it,  and  finally  the  bad  consequences  make  themselves 
felt. 

We  have  now  seen  that  the  principal  cause  of  this 
general  spreading  of  onanism  is  innate  in  human  nature 
itself,  and  is  most  commonly  seduction.  If,  then,  we 
speak  of  further  causes  of  this  disease,  we  shall  under- 
stand thereby  rather  the  occasions  that  help  in  the  de- 
velopment of  the  germ.  They  do  not  cause  onanism, 
properly  speaking,  but  rather  its  immoderate  practice. 

The  leader  in  these  causes  of  onanism  is  the  sedentary 
mode  of  life  to  which  our  youth  is  generally  condemned, 
— the  icant  of  out-door  exercise,  the  curse  of  the  present 
customary  mode  of  education. 

Flogging  on  the  bare  back  or  buttocks  is  apt  to  incite 
to  premature  activity  the  sexual  organs,  or,  rather,  the 
nerves  which  lead  from  the  center  of  erection  through 
the  spinal  cord.  This  alone  ought  to  be  reason  enough 
to  induce  us  to  abrogate  as  much  as  possible  the  brutal 
and  absolutely  unnecessary  Avhipping  of  children.  On 
some  future  occasion  we  shall  show  that  such  blows 
applied  on  the  back  and  buttocks  constitute  a  brutally 
empiric  aphrodisiac. 

Then,  too,  we  have  lascivious  reading  and  pictures 
which,  heating  the  imagination,  for  the  time  being  incite 
the  sexual  instinct  in  the  highest  degree,  and  must  be 
the  cause  of  many  excesses  in  onanism.  Theaters,  balls, 
and  other  entertainments  where  young  men  come  in 


170  SEXUAL  IMPOTENCE. 

direct,  or  indirect  contact,  with  the  female  sex  are  rather 
effective  preventives  against  immoderate  onanism,  in 
spite  of  the  demonstrations  of  all  the  misanthropic  or 
thoughtless  persons  who  never  see  anything  beyond  the 
sphere  of  their  rooms. 

I  must  raise  my  voice  against  those  numerous  authors 
who  denounce  riding  on  horseback  as  a  cause  of  onan- 
ism. Riding,  like  every  bodily  exercise,  is  not  conducive 
to^onanism,  and  whoever  asserts  differently  gives  a  proof 
of  his  want  of  knowledge  on  the  subject.  These  gentle- 
men ape  Lallemand  always  and  in  everything,  while  they 
also  seize  every  opportunity  for  ridiculing  his  views. 

As  determining  causes  of  excess  in  onanism  I  must 
denounce  idleness  and  loitering  about,  which  occasionally 
become  habits  even  with  very  assiduous  youths ;  also 
going  to  bed  too  early  and  arising  too  late,  especially 
lying  in  bed  awake  in  the  morning.  Again,  stimulating 
foods  and  drinks  may  prove  to  be  determining  causes  for 
excesses  in  onanism. 

Another  powerful  cause  in  the  propagation  of  onanism 
is  the  temporary  or  permanent  impossibility  of  procur- 
ing a  woman.  The  concupiscent  desire  increases,  and 
finally  even  an  energetic  man  of  character  may  succumb. 
Again,  uncleanliness  may  cause  an  accumulation  of  a 
sebaceous  mass  between  the  prepuce  and  the  glans,  in- 
ducing continual  itching,  and  thus  the  hands  will  be 
induced  to  manipulate  the  member,  this  possibly  ending 
in  onanism. 

As  other  causes  of  onanism  may  be  mentioned  stone 
in  the  bladder,  various  kinds  of  irritation  about  the 
promontory  and  the  neck  of  the  bladder,  and  certain 
cutaneous  diseases,  especially  phimosis  and  balanitis. 
Oxyuris  worms  also,  by  setting  up  an  itching  or  irrita- 


FORMS  OF  IMPOTENCE.  171 

tion  about  the  genitals,  may  cause  onanism.  Since  Lal- 
lemand,  however,  too  much  stress  has  been  laid  on  the 
frequency  of  these  causes  of  onanism. 

Some  authors  blame  the  working  of  sewing-machines 
for  causing  onanism.  The  possibility  of  this  cannot  be 
denied,  but,  as  Dr.  Decaisne  *  says,  a  good  deal  of  will- 
ingness is  necessary. 

In  the  last  instance  we  shall  mention  too  tight  garments 
as  a  cause  of  onanism.  These  may,  by  means  of  fric- 
tion, lead  indirectly  to  onanism,  but  only  if  the  genitals 
are  already  in  a  state  of  irritation. 

In  some  exceedingly  rare  cases  an  inherited  neuro- 
psychopathic  predisposition  may,  in  very  young  chil- 
dren, cause  premature  awakening  of  the  sexual  instinct. 
The  inevitable  result  will  be  onanism. 

The  consequences  of  onanism  never  tarry  long  in 
showing  themselves.  Since,  in  most  cases,  undevel- 
oped individuals  are  given  to  excess  in  onanism,  the 
whole  organism  soon  suffers  from  the  excitement  and 
the  continual  loss  of  sperm.  These  stimulations  are  too 
frequent  and  too  violent  for  the  undeveloped  nervous 
system.  The  change  of  substance  in  the  body  is  rapid 
enough,  so  that  recuperation  from  the  frequent  loss  of 
substance  would  not  cause  much  disturbance  in  the  sys- 
tem if  the  individual  were  not  in  great  need  of  all  his 
force  and  all  the  energy  of  his  metabolism  for  his  growth 
and  further  development.  Hence  we  see  that  delicate 
and  sickly  individuals  suffer  under  excess  in  onanism  a 
great  deal  more  than  strong  and  healthy  ones. 

First  anemia  is  produced,  under  the  influence  of  which 
the  digestive  activity  suffers,  and,  consequently,  the  whole 

1  Fournier,  De  1'Onanisme.     Paris,  1885,  p.  67. 


]72  SK.M'AL    I. MI'OTKXCK. 

body.  Again,  the  shock  resulting  from  the  practice  of 
onanism  enervates  the  whole  system,  and,  less  fre- 
quently, causes  in  the  nervous  system  a  state  of  exci- 
tability. The  nervous  system  has  but  little  power  of 
resistance,  and  the  shock  is  repeated  very  frequently. 

Many  forms  of  neurasthenia  have  their  origin  in  onan- 
ism. With  young  children  onanism  may  even  cause  far 
more  profound  disturbances  of  the  nervous  system.  I 
have  seen  a  boy  nine  years  old  suffering  from  epilepti- 
form  attacks  arising  from  onanism  only;  the  attacks 
ceased  upon  the  application  of  an  ingeniously  arranged 
bandage.  I  doubt,  however,  that  onanism  can  cause 
real  and  permanent  epilepsy.  The  effect  of  onanism 
upon  the  nervous  system  is  specially  pernicious  in  c;ises 
where  children  begin  onanism  before  there  is  any  sperm. 
Here  there  can  be  no  question  of  loss  of  substance.  The 
time  of  production  of  sperm  is  in  such  cases  considerably 
accelerated. 

The  assertion  that  onanism  causes  tabes  dorsalis  is 
certainly  an  extravagant  fancy.  To  attempt  to  prove 
such  an  assertion  by  stating  that  of  one  hundred  and 
nine  cases  of  tabes,  ninety-seven  of  the  patients  con- 
fessed to  onanism,  as  Fournier  l  says,  is  a  mistake.  Four- 
nier's  report  proves  only  that  of  one  hundred  and  nine 
people  at  least  ninety-seven  have  practised  onanism  at 
some  time,  and  that  most  of  them  are  ever  ready  to  look 
upon  any  disorder  in  the  conditions  of  health  as  a  result 
of  this  wretched  habit.  The  consequences  of  onanism 
are  serious  enough ;  there  is  no  necessity  to  add  any- 
thing from  sheer  fancy. 

As  to  the  special  effect  of  excesses  in  onanism,  we 

1  Op.  cit.,  p.  125. 


KORMS  OF   IMPOTENCE.  173 

state,  in  the  first  place,  that  the  sensibility  of  the  sexual 
or</(tiiM  /x  hcif/lttcncd,  and,  in  time,  to  an  excessive  degree. 
Very  soon  a  hyperesthetic  form  of  sexual  neurasthenia 
develops,  which,  by  itself,  can  cause  impotence. 

Edward  Martin l  says,  "  Masturbation  unquestionably 
determines  at  first  acute  hyperesthesia  and  hyperemia 
of  the  prostatic  urethra.  This  is  ultimately  followed  by 
a  chronic  congestion  and  by  almost  complete  anesthesia 
of  the  same  region.1'  I,  for  my  part,  never  was  able  to 
observe  chronic  congestion  and  any  degree  of  anesthesia 
Ingether,  but  always  found  that,  whenever  there  was 
congestion,  hyperesthesia  never  was  missing. 

Besides,  excess  in  onanism,  in  a  much  higher  degree 
than  excess  in  venery,  is  a  cause  of  a  gradually  in- 
creasing frigidity  and  (ircrxtoii  for  the  other  sex.  This 
aversion  is  at  the  same  time  a  cause  and  a  consequence 
of  impotence.  The  patient  is  impotent  because  he  feels 
an  aversion  for  the  female  sex,  and  lie  is  averse  to  the 
female  sex'  because  he  feels  himself  impotent.  In  the 
midst  of  the  absurd  and  crazy  social  institutions  of  our 
time  such  people  often  assume  the  role  of  heroes  of  vir- 
tue, and  are  set  as  examples  for  others  who  have  the 
misfortune  (?)  of  being  somewhat  virile.  Again,  excesses 
in  onanism  are  more  frequently  the  cause  of  perverted 
sexual  sensation  than  are  excesses  in  venery. 

The  augmented  sensibility  of  the  sexual  organs  is  the 
chief  cause  of  the  pollutions  that  invariably  follow  ex- 
cesses in  onanism  ;  these  pollutions  are  finally  followed 
by  sperm atorrhea,  and  have  impotence  as  their  conse- 
quence. A  relaxation  of  the  entire  sexual  apparatus 

1  Impotence  and  Sterility.  Hare,  System  of  Practical  Therapeu- 
tics, vol.  iii.  p.  662. 


174  SEXUAL   IMPOTENT  K. 

occurs  simultaneously  with  the  over-excitement  of  the 
srMial  nerves  and  their  centers.  In  this  enfeeblement, 
as  a  matter  of  course,  the  muscular  apparatus  of  the 
(hut us  ejaculatorii  participates,  whereby  a  further  con- 
dition arises  tending  toward  excessive  pollutions  and 
spermatorrhea.  Of  course,  enfeeblement  of  the  whole 
organism  and  weakening  of  the  sexual  organs  go  hand 
in  hand  and  keep  nearly  apace  with  each  other.  Some- 
times the  rest  of  the  body  still  presents  a  quite  satis- 
factory state,  whilst  there  is  already  great  disturbance 
in  the  functions  of  the  sexual  organs.  This  is  the  case 
chiefly  with  onanists  of  mature  age  who  are  affected  by 
hereditary  low  sexual  power  of  little  resistance. 

Finally,  it  is  asserted  that  excessive  onanism  may 
cause  atrophy  of  the  testicles.  Such  cases  being  described 
by  Curling  and  Albert,1 1  will  only  point  to  their  extraor- 
dinary scarcity,  without  giving  expression  to  my  doubts. 
It  is  more  probable  that  atrophy  of  the  testicles  did  not 
occur  until  onanism  had  caused  impotence. 

The  most  frequent  and  therefore  best  observed  dis- 
eases caused  by  excess  in  onanism  are  immoderate 
pollutions  and  consequent  spermatorrhea.  Knowing. 
as  we  do,  that  onanism  is  an  evil  of  long  standing.  \v<- 
shall  not  be  surprised  if  Moses  knew  of  the  pollutions.2 
According  to  his  regulations,  a  man  who  had  an  effusion 
of  semen  was  unclean  for  a  whole  day,  and  likewise  the 
woman  who  may  have  been  lying  with  him. 

Too  frequent  pollutions  are  the  most  common  causes 


1  Hofmann,  Lehrbuch  der  gerichtlichen  Medicin.  Wien,  1881, 
p.  63. 

*  Trusen,  Darstellung  der  biblischen  Krankheiten.  Posen,  1843, 
p.  9. 


FORMS  OF  IMPOTENCE.  175 

of  impotence,  and  we  may,  therefore,  say  with  some 
authority  that  onanism  is  the  cause  of  impotence  in  the 
great  majority  of  cases.  Of  one  hundred  persons  suf- 
fering from  pollutions  there  were  at  least  ninety-nine 
addicted  to  onanism,  so  that  all  other  causes  together 
hardly  ever  come  under  consideration. 

If  a  healthy,  robust  person,  in  full  possession  of  his 
.sexual  power,  does  not  in  anywise  satisfy  his  sexual 
wants,  and  if  the  glands  preparing  the  sperm  do  not 
cease  their  action,  an  ever-increasing  quantity  of  semen 
collects  in  them,  causing  a  very  great  tension,  particu- 
larly in  the  seminal  vessels,  and  this  leads  to  so-called 
physiological  pollutions. 

Now  the  question  arises,  How  frequent  may  these  be 
before  they  should  be  called  excessive?  Some  authors 
have  even  pretended  to  fix  the  limits  within  which  pol- 
lutions may  be  repeated.  This  is,  however,  not  admis- 
sible, since  the  sexual  organs  do  not  act  with  the  same 
energy  with  all  persons,  and  the  number  of  pollutions 
during  a  time  of  abstinence  cannot  be  the  same  with 
individuals  who  were  accustomed  to  daily  intercourse, 
and  with  others  who  indulged  only  once  a  week.  There- 
fore we  have  to  consider  as  decisive  not  numbers  but 
the  circumstances  that  accompany  and  follow  the  invol- 
untary loss  of  semen.  Besides,  the  great  divergence  in 
the  frequency  considered  normal  by  different  authors  is 
sufficient  proof  of  their  unreliability. 

A  pollution  must  be  called  normal  under  the  follow- 
ing conditions  :  it  must,  first  of  all,  occur  during  sleep, — 
i.e.,  during  absence  of  consciousness  and  will-power; 
it  must  be  accompanied  by  a  vigorous  erection,  erotic 
dreams,  and  by  the  natural  sensual  gratification  ;  it  must 
cause  a  sensation  of  well  feeling  and  relief,  but  not  of 


I7<;  SKXTAI,  IMI-OTKNCK. 

faint  ness,  depression,  headache,  or  other  similar  troubles. 
If  any  one  of  these  conditions  is  missing,  the  pollution 
must  be  considered  morbid. 

We  shall,  with  Curschmann,1  classify  morbid  pollu- 
tions as  follows : 

I.    Mnrb'ul  i>ol/iifioiix  occiirrin;/  iltn-'nuj  x/c<'j>. 

a.  The  pollutions  are  more  frequent  than  is  normal 
according  to  the  peculiarities  of  the  individual  and  the 
natural  state  of  his  semen  secretion.  The  accompanying 
phenomena  are  unchanged,  but  the  patient  feels  after- 
ward faint,  low-spirited,  and  is  sometimes  troubled  with 
headache,  etc. 

l>.  The  number  of  pollutions  reaches  such  a  height  that 
they  appear  for  this  reason  alone  as  pathological.  The 
pollutions  may  occur  every  night,  or  even  more  than 
once  in  one  night.  Moreover,  they  may  occur  some- 
times directly  after  coitus,  and  even  in  a  bed  that  is 
shared  with  a  woman.  The  accompanying  phenomena 
still  resemble  those  of  normal  pollutions,  but  the  conse- 
quent pathological  sensations  are  still  more  marked  than 
in  group  a. 

c.  There  is  very  great  frequency,  but  an  absence  of 
the  phenomena  accompanying  nonnaf  j»>/(nti<nix,  such  as 
erection,  erotic  dreams,  and  voluptuous  sensations.  The 
ejaculated  semen  is  very  small  in  quantity,  and  in  quality 
a  thin  liquid.  In  this  group  of  morbid  pollutions  the 
psychical  shock  and  the  loss  of  substance  are  both  in- 
significant, and  yet  the  consequent  phenomena  are  very 
grave. 


1  Die  functionellen  Storungen  der  rnannlichen  Genitalien.  Ziems- 
sen's  Handbuch  der  speciellen  Pathologie  und  Therapie.  Ifcind 
ix.,  Halfte  2,  p.  467. 


FORMS  OF  IMPOTENCE.  177 

II.  Morbid  pollutions  in  the  waking  state. 

a.  The  pollutions  take  place  while  the  individual  is 
awake,  in  consequence  of  trifling  mechanical  irritation,  such 
as  friction  by  a  tight  garment,  riding  on  horseback  or  in 
some  conveyance. 

b.  The  so-called  diurnal  pollutions  happen  even  under 
the  impress  of  psychical  influence.     Finally,  as  the  last 
form  : 

c.  The    patient    loses    semen    during   micturition  or 
defecation. 

In  reference  to  the  above  and  similar  classifications  it 
must  be  remarked,  however,  that  loss  of  semen  during 
the  waking  state  occurs  frequently  without  coming  under 
the  head  of  an  aggravated  state  of  morbid  pollutions. 
Spermatorrhea,  particularly  following  an  obstinate  gonor- 
rhea, is  to  be  considered  a  case  of  this  kind. 

Most  authors  distinguish  between  pollutions  and  sper- 
matorrhea,  but  their  definitions  of  spermatorrhea  are 
quite  varying,  the  limit  between  pollution  and  sper- 
matorrhea being  fixed  differently  by  different  authors. 
Since,  however,  these  distinctions  are  of  no  value  in 
therapeutics,  we  shall,  with  Curschmann,  give  the  name 
of  spermatorrhea  to  those  forms  of  pollutions  that  are 
of  a  high  degree  and  take  place  during  consciousness. 
Roubaud *  gives  the  name  pollutions  to  those  losses  of 
semen  which  are  accompanied  by  venereal  orgasm,  and 
spermatorrhea  to  those  that  are  unaccompanied  by  sex- 
ual desire  or  erection  or  voluptuous  sensation.  Older 
authors  have  described  by  the  name  spermatorrhea  a 
state  in  which  sperm  is  said  to  flow  continuously. 
Since  we  have  no  trustworthy  report  of  any  such  case, 


1  Op.  cit.,  p.  327. 
12 


178  sr.XlTAL   IMI'OTKNCK. 

we  cannot  have  any  faith  in  tlio  above  statement. 
although  w«l  admit  the  possibility  that,  if  the  organs  of 
ejaculation  have  ceased  to  act,  the  sperm  may  How  oil' 
as  it  is  secreted.  We  must  lay  special  stress  on  tlic  fact 
that  although  morbid  pollutions  occur  very  frequently, 
yet  those  of  a  high  degree  which  deserve  the  name  of 
spermatorrhea  are  exceedingly  rare. 

To  Lallemand  is  due  the  merit  of  having  directed  the 
attention  of  the  medical  profession  to  this  disease  of 
morbid  pollutions,  which  till  then  had  been  well-nigh 
neglected,  and  we  can  gladly  overlook  the  exaggerations 
to  which  he  may  easily  have  been  misled.  Modern 
authors  profit  by  his  investigations,  and  yet  ridicule  the 
man  who  has  written  his  name  indelibly  on  modem 
pathology  and  therapeutics  of  pathological  sperm  effusion. 
This  keen  observer  has  studied  and  described  the  nature 
of  this  disease  so  precisely  that  the  authors  of  to-day 
can  only  express  in  other  terms  what  has  already  been 
said  by  Lallemand.  If  they  deviate  essentially  from  his 
path,  they  are  generally  in  the  wrong.  His  method  of 
cauterizing  is  still  the  alpha  and  omega  of  the  treatment 
of  this  disease,  although  variously  modified  and  named. 
It  would  be  an  injustice  if  we  were  to  blame  him  for 
seeing  in  every  one  of  his  patients  an  individual  affected 
with  spermatorrhea,  and  for  having  an  unlimited  confi- 
dence in  his  method  of  cauterizing.  Some  of  our  cele- 
brated specialists  have  similar  weaknesses. 

Lallemand  unquestionably  deserves  the  credit  of  hav- 
ing proved  that  excessive  loss  of  sperm  is  a  disease  or, 
at  least,  a  symptom  of  disease,  which  can  and  must  be 
treated.  Of  what  use  to  a  man  who  suffers  from  weaken- 
ing pollutions  is  a  physician  who,  following  the  example 
of  renowned  clinicians,  laughs  at  him  and  sends  him 


FORMS   OF   IMPOTENCE.  179 

home  with  some  insignificant  and  useless  prescription? 
You  should  see  the  despair  that  takes  -hold  of  such  an 
unfortunate  being  when  he  sees  what  little  importance 
the  doctor  attaches  to  his  condition,  which,  he  feels,  is 
sapping  all  his  physical  and  mental  strength. 

It  is  a  poor  consolation  to  say  that  only  the  minority 
of  the  patients  asking  for  advice  about  losses  of  sperm 
are  really  suffering  from  pathological  pollutions.  Such 
assertions  coming  from  competent  men 1  are  apt  to  make 
the  physician  careless  or  indifferent  in  the  treatment  of 
this  so  eminently  serious  disease,  and  to  induce  him  to 
consider  these  pitiable  persons  as  sufferers  through  the 
imagination.  I  am,  on  the  contrary,  of  the  opinion  that 
such  patients,  with  but  few  exceptions,  are  in  great  need 
of  medical  help  for  these  excessive  pollutions,  which  may 
not  kill  them  •  at  once,  but  which  cause  an  irreparable 
loss  of  general  and  sexual  force.  The  sooner  such 
patients  consult  the  physician,  the  more  wisely  they  act, 
because  chronic  evils  are  more  difficult  to  treat. 

Eulenburg's 2  opinion  seems  to  me  very  plausible.  He 
says,  "  I  believe  that  a  pollution  is  no  more  to  be  con- 
sidered as  normal  than  a  cough  or  vomiting,  and  that 
even  the  so-called  normal  pollutions  originate  really  in 
some  unusual  and  exceptional  irritation,  which  may  be 
comparatively  light,  but  which  acts  upon  the  center  of 
ejaculation." 

It  has  already  been  pointed  out  that  onanism  is  nearly 
the  only  cause  of  morbid  pollutions.  Cases,  however,  may 
be  met  with  in  which  morbid  pollutions  are  also  caused 
by  acute  inflammatory  conditions  in  the  urethra,  such  as 

1  Curschmann,  op.  cit.,  p.  495. 

2  Sexuale  Neuropathie.    Leipzig,  1895,  p.  55. 


180  SKXTAL    IMI'nTKXCE. 

gonorrhea,  inflammation,  and  tumors  of  the  seminal  ves- 
M  Irs,  chronic  inflammation  of  the  neck  of  the  bladder 
and  of  'the  pars  prostatica  urethroe.  Phimosis,  various 
diseases  of  the  rectum,  such  as  piles,  fissures,  eczema, 
and  other  cutaneous  eruptions  of  the  rectum  and  its 
vicinity,  are,  since  Lallemand's  time,  accused  of  being 
the  cause  of  morbid  pollutions.  Such  causes  as  these 
are  seldom  observed  and  taken  into  account,  although 
the  accumulation  of  smegma  in  consequence  of  phi  mo- 
sis,  the  presence  of  oxyuris  vermicularis  in  the  rectum, 
or  other  diseases  producing  irritation  in  or  about  the 
genitals,  may  easily  cause  erections  and  also  nocturnal 
emissions.  We  have  already  seen  that  such  diseases  are 
causes  of  onanism,  and,  indirectly,  of  pollutions. 

It  is  a  disputed  question  whether  obstipation  and  dffi- 
cutt  defecation  are  capable  of  causing  pollutions  and 
spermatorrhea.  It  seems  very  plausible  that  the  press- 
ure of  hard  and  voluminous  scybala  and  forced  contrac- 
tion of  the  rectum  may  force  out  some  seminal  liquid. 
There  is  no  doubt  that  masses  of  feces  which  have  col- 
lected in  the  rectum  can  cause  erections  and  nocturnal 
emissions  in  consequence  of  the  pressure  and  incitement 
they  may  exercise  on  the  sexual  organs.  It  is  more  than 
doubtful,  however,  that  with  a  healthy  man  the  difficulty 
in  connection  with  defecation  is  able  to  press  sperm  out 
of  the  seminal  vessels.  We  would  rather  agree  with 
Curschmann's '  view,  which  he  expresses  thus :  "  Theo- 
retically considered,  the  opinion  made  reference  to — 
viz.,  pressure  from  the  rectum  on  the  seminal  vesicles — 
is  not  so  plausible  as  it  would  at  first  appear.  These 
vesicles  are  so  placed  between  the  bladder  and  the  rec- 

1  Op.  cit.,  p.  488. 


FORMS   OF  IMPOTENCE.  181 

turn  that  they  have  free  motion,  and  can  thus  easily  give 
way  to  pressure  coming  from  the  rectum,  so  that  the 
latter  would  be  more  likely  to  exercise  any  action  on  the 
closely  joined  and  well-fixed  ducts  and  their  orifices  than 
on  the  widely  diverging  blind  ends  of  these  formations. 
But  pressure  on  the  orifices  of  the  seminal  ducts  would 
rath  or  have  a  closing  effect  than  otherwise." 

The  explanation  of  the  origin  of  this  liquid  would 
have  far  more  anatomical  probability  if  applied  to  the 
prostatic  humor.  The  prostata,  as  is  known,  is  firmly 
fixed  in  the  pelvis,  and  so  placed  between  the  fundus  of 
the  bladder  and  the  expansion  of  the  rectum,  situated 
immediately  above  the  anus  (and  particularly  well  de- 
veloped towards  the  front),  that  the  hard  feces  must 
almost  of  necessity  be  pressed  against  the  prostata  by  the 
pressure  of  the  sphincter  ani,  which  acts  from  before 
backward.  I  had  repeated  opportunities  of  examining 
microscopically  sperm-like  liquid  wrhich  different  men 
emitted  during  difficult  defecation,  and  which  they  be- 
lieved to  be  semen.  In  but  few  cases  could  I  find  any 
seminal  filaments,  and  in  these  cases  I  also  discovered 
other  evidences  of  spermatorrhea. 

Very  seldom  are  morbid  pollutions  produced  by  gen- 
end  diseases,  as  anemia,  general  debility,  and  neurasthe- 
nia. By  the  side  of  all  these  causes,  which  rarely  come 
under  observation,  onanism  remains  almost  the  only 
cause  of  morbid  pollutions  that  invites  closer  medical 
attention. 

Why  does  onanism  cause  pollutions  f  We  have  already 
answered  this  question.  The  conditions  that  make 
onanism  more  likely  to  cause  morbid  pollutions  are  the 
youthfulness  of  most  onanists  and  the  facility  with  which 
they  can,  at  any  time  and  in  any  place,  indulge  in  their 


182  >i;\l.\L    IMl'OTKXCK. 

evil  habit.  Excessive  onanism,  or  onanisni  in  general 
with  individuals  whose  power  of  resistance  is  still  low, 
causes,  almost  without  exception,  a  state  of  slight  in- 
flammation about  the  ductus  ejaculatorii.  This  inflam- 
mation produces  in  the  vessels  that  convey  the  sperm 
an  irritability  of  so  high  a  degree  that  it  is  altogether  out 
of  proportion  to  its  cause,  and  this  irritability  is,  with 
rare  exceptions,  the  cause  of  the  morbid  pollutions. 
The  congestion  probably  never  reaches  such  a  point  that 
a  catarrhal  secretion  could  be  ascertained.1  A  slight 
swelling  and  reddening  of  the  pars  prostatica  urethra} 
can  always  be  traced,  and  upon  this  fact  we  may  estab- 
lish, with  the  greatest  plausibility,  our  diagnosis  of  ex- 
cessive onanism,  if  we  exclude  any  previous  gonorrheal 
inflammation  of  the  urethra.  It  must,  however,  be  re- 
marked that  the  pollutions,  if  they  last  a  long  time,  cause 
by  themselves  chronic  inflammation  of  the  caput  gal- 
linaginis.  This  swelling  and  reddening  will  generally 
disappear  as  soon  as  the  morbid  pollutions  begin  to  pass 
over  into  that  stadium  which  is  commonly  called  sper- 
matorrhea.  In  this  the  caput  gallinaginis  turns  pale  and 
atrophies.  This  same  cause  probably  induces  the  re- 
laxation of  the  orbicularis  muscles  of  the  ductus  ejacula- 
torii, which  is  followed  by  a  dilatation  of  the  same,  and, 
finally,  by  spermatorrhea. 

These  local  changes  are  probably  the  immediate  cause 
of  the  pollutions,  but  neither  can,  with  any  reason,  be 
considered  an  independent  disease,  as  they  are  merely 
symptoms  of  the  disease  consequent  on  onanism. 

We  have  seen  that  the  pollutions  are  caused  by  the 


1  FUrbringer,  Eulenburg's  Real-Encyclopadie.    Wien  und  Leip- 
zig, 1888,  Band  xiv.  p.  596. 


FORMS  OF   IMPOTENCE.  133 

irritation  as  well  as  the  relaxation  of  the  spermatic  pas- 
sages. An  attempt  has  accordingly  been  made  to  dis- 
tinguish two  forms  of  morbid  pollutions.  However 
valuable  it  may  be  in  therapeutics,  this  distinction  can- 
not be  accepted  as  valid,  but  must  give  way  to  the  asser- 
tion that  the  states  of  irritation  and  of  relaxation  are 
different  stages  of  one  and  the  same  disease.  The  for- 
mer always  precedes  the  latter;  but  both  occasionally 
exist  at  the  same  time. 

When  once  the  pollutions  have  become  chronic,  then 
\vr  have  also  to  deal  with  the  influence  of  habit,  which 
is  sometimes  quite  incomprehensible  in  the  case  of  many 
organs,  and  offers  an  obstacle  to  the  cure  of  pollutions 
even  when  their  causes  have  been  removed.  There  are 
individuals  who  are  naturally  predisposed  to  morbid 
losses  or  effusions  of  semen,  in  whom  they  are  caused 
by  the  most  trifling  excesses. 

The  diagnosis  of  morbid  pollutions  is  an  easy  task,  but 
Ihc  diagnosis  of  spermatorrhea  is  frecjuently  more  diffi- 
cult. It  is  absolutely  indispensable  that  the  semen  be 
examined  microscopically,  whether  discharged  by  ejacu- 
lation or  otherwise,  and  the  patient  himself  must  be 
subjected  to  an  examination  with  the  endoscope. 

The  results  of  such  sperm  examinations  from  morbid 
pollutions  are  very  various.  Spermatozoids  are  found 
in  variable  quantity,  being  absent  only  in  spermatorrhea 
of  a  high  degree.  In  the  same  patient  suffering  from 
morbid  pollutions  there  are  found,  at  one  time,  quite 
well-developed  spermatozoa,  appearing  dark  in  the  field 
of  vision  and  provided  with  long  tails,  while  at  another 
time  almost  nothing  but  young  formations  with  light, 
water-colored  heads  and  short  tails.  A  remarkable  fact 
is  that  after  a  pause  of  several  days  between  pollutions 


1£4  SKXT.M,    IMI'OTK.NVK. 

you  will  find  the  seminal  filaments  very  sparing  in  the 
ejaculated  semen,  whilst  the  filaments  appear  more  nu- 
merous in  sperm  from  pollutions  repeated  after  short 
intervals. 

I  have  made  numerous  microscopic  examinations  of 
sperm  coming  from  pollutions.  It  has  been  mostly  sperm 
from  prisoners,  and  only  in  a  few  cases  from  private  pa- 
tients. These  examinations  have  convinced  me  thai  I  lie 
spermatic  fluid  of  morbid  pollutions  does  not  differ  from 
semen  ejaculated  otherwise,  in  the  quantity  or  in  the 
form  of  spermatozoa,  if  we  exclude  the  comparatively 
rare  cases  of  spermatorrhea  of  a  high  degree.  The  dif- 
ference is  only  in  the  lesser  vitality  of  these  filaments. 

The  filaments  in  sperm  ejaculated  during  intercourse 
are  partly  alive  after  a  lapse  of  forty-eight  hours,  if  the 
fluid  has  been  preserved  under  favorable  circumstances  ; 
those  from  pollutions  are,  without  exception,  dead  after 
a  few  hours.  Even  spermatozoa  coming  from  pollu- 
tions which  the  majority  of  authors  would  call  physio- 
logical have  much  less  vitality  than  others  discharged  in 
coitus,  for  instance.  This  can  easily  be  demonstrated 
by  the  examination  of  semen  from  the  same  person,  but 
discharged  at  one  time  in  pollution  and  at  another  in  co- 
ition. My  experiences  in  this  line  are  not  in  conformity 
with  Furbringer's1  views  on  the  relations  of  the  products 
of  the  prostata  to  the  seminal  fluid,  though  recent  and 
at  this  time  unfinished  experiments  have  caused  some 
doubts  in  my  mind. 

The  result  of  endoscopie  examinations  has  been  spoken 
of  already,  and  we  here  add  merely  that,  since  the 

1  Die  StSrungen  df  r  Geschlechtsfunctionen  des  Mannes.  Wien, 
1895,  pp.  8,  9. 


FORMS  OF  IMPOTENCE.  185 

urethra  of  a  patient  affected  with  spermatorrhea  and 
pollutions  is  very  highly  sensitive,  the  introduction  of  a 
sound  or  of  an  endoscope  necessitates  the  greatest  care 
and  gentleness  possible. 

The  result  of  an  endoscopic  examination  is  negative 
only  when  the  morbid  pollutions  are  caused  by  hyperes- 
Ilicsiaof  the  sexual  centra, — a  case  which  is  certainly 
very  rare,  since  an  individual  whose  ejaculatory  organs 
are  in  good  condition  may  lie  the  whole  night  with  an 
erection  and  be  visited  by  erotic  dreams  without  suffer- 
ing any  loss  of  sperm.  The  result  of  such  examination 
with  an  endoscope  may  also  be  negative  if  the  morbid 
pollutions  have  appeared  among  the  sequelae  of  some 
nervous  disease  ;  but  this  also  would  be  true  in  the  be- 
ginning only,  because,  if  the  pollutions  continue  during 
a  longer  period,  changes  about  the  ductus  ejaculatorii 
begin  to  make  themselves  noticed.  On  the  whole,  the 
cause  of  pollutions  has  very  seldom  to  be  looked  for  in 
the  direction  of  the  centra,  because,  in  the  great  majority 
of  cases,  the  excessive  losses  of  semen  are  occasioned 
by  local  disease. 

In  most  cases  of  morbid  pollutions  the  exterior  ap- 
pcarancc  of  tin-  wiiaf  oryan*  points  to  morbid  changes. 
The  penis  and  testicles  with  their  surroundings  have 
generally  a  flabby,  withered  look  ;  the  testicles  hang 
lower  than  they  should,  and  are  sometimes  sensitive 
to  even  light  pressure.  Almost  without  exception  there 
is  a  diminution  of  the  warmth,  sensitiveness,  and  irrita- 
bility of  the  exterior  sexual  parts. 

The  general  state  of  health  and  appearance  of  the  pa- 
tient are  more  or  less  sickly  in  proportion  to  the  grade 
of  disease.  Here  and  there  you  may  s.ee  persons  hav- 
ing a  very  healthful  appearance  who  are  nevertheless 


18(j  SKM'AL    IMI'OTKNCK. 

affected  with  morbid  pollutions  of  a  high  derive.  When 
you  set  your  eyes  on  sucli  a  miserable,  pitiful  being,  who, 
although  gifted  with  some  power  of  resistance,  never- 
theless ends  by  losing  health  mid  sexual  power,  you  in- 
voluntarily ask  yourself  whether  he  can  possibly  be  the 
object  of  such  poor  raillery  as  may  be  read  in  Niemayer's 
"Manual  of  Special  Pathology  and  Therapeutics." 

The  patient  is  sickly  in  appearance,  and  presents  the 
picture  of  exhaustion  in  most  cases, — without  excep- 
tion in  cases  of  a  high  degree.  The  chief  disorders  or 
troubles  make  themselves  felt  in  the  digestive  organs 
and  in  the  nervous  system,  the  deleterious  influence  on 
virility  being  constant  and  finally  destroying  it  totally. 

In  this  diminution  of  virility  and  in  the  incessant  pon- 
dering over  the  loss  of  semen,  repeating  itself  without 
remission  and  driving  the  patient  to  despair,  is  most 
often  to  be  found  the  cause  of  the  changes  in  the  char- 
acter which  are  nearly  always  observable  in  such  patients. 
.Although  a  rational  investigator  cannot,  even  by  a 
thorough  study  of  the  pollutions,  discover  any  advantage 
in  this  kind  of  discharge  of  sperm,  yet  there  have  been 
amongst  authors  ones  who,  while  arousing  a  horror  of 
every  copulation  outside  of  wedlock,  have  gone  so  far  as 
to  speak  of  the  pollutions  as  a  wise  provision  of  nature. 

Thus  there  arise  the  questions,  Are  the  pollutions 
necessary,  and  Are  they  of  any  advantage  to  man? 
"  No'1  is  the  answer  to  both  questions.  I  will  not  speak 
of  the  wasteful  spilling  of  the  precious  fluid  which  had 
better  be  used  for  the  creation  of  new  human  beings, 
since  it  would  be  a  real  misfortune  for  mankind  if  all 
sperm  were  so  used.  The  waste  of  sperm  has  its  cause 
in  the  course  of  nature  ;  but  another  circumstance  claims 
our  attention.  The  sexual  power  of  man  is  one  of  those 


FORMS  OF   IMPOTENCE.  187 

few  real  pleasures  of  our  existence,  and  the  pollutions 
deprive  many  a  one  of  a  considerable  share  of  these 
enjoyments,  which  are  in  any  case  only  sparingly  meted 
out.  Pollutions  should  never  be  allowed  to  exist  in  any 
one,  for  they  can  have  only  one  of  two  things  as  their 
cause  :  either  they  prove  a  real  want  that  is  not  satisfied, 
or  they  are  the  symptom  of  some  disease.  In  the  former 
case  the  individual  concerned  should  do  his  utmost  to 
obtain  his  share  in  the  enjoyments  of  life ;  in  the  latter 
case  the  sufferer  ought  to  seek  help,  as  it  is  his  duty  to 
do.  The  main  cause  of  the  lack  of  spirit  and  the  help- 
lessness of  these  sufferers  lies  in  the  present  views  of 
the  leading  professional  spirits.  If  they  show  any  feel- 
ing for  these  pitiable  individuals,  it  is  a  sympathizing 
shrug  of  the  shoulders  at  best,  or  it  may  be  a  scorn,  since 
life  is  not  at  stake. 

My  conviction  is  that  pollutions  will  soon  be  can- 
celled from  the  list  of  physiological  functions,  and  treated 
as  a  pathological  symptom.  I  am  so  much  the  more  in- 
clined to  this  view,  as  I  am  not  aware  that  pollutions 
have  ever  been  noticed  in  animals. 

The  injurious  effect  of  sexual  excesses  on  the  func- 
tional capacity  of  the  sexual  organs  is  an  admitted  fact, 
and  has  been  generally  rather  exaggerated  than  under- 
estimated, as  is  the  case  to-day.  Many  men  of  the  medi- 
cal profession,  who  felt  it  incumbent  to  play  the  role  of 
moralist,  have  at  all  times  decreed  the  most  horrifying 
chastisements  on  disobedience  to  the  sixth  command- 
ment of  God.  These  gentlemen  of  such  high  morality 
have  too  often  encroached  upon  the  legislative  power, 
but,  luckily,  they  were  not  invested  with  executive 
power,  and  hence  it  comes  that  many  members  of  frail 
humanity,  so  sinful  ever  since  the  time  of  Adam,  and 


1SS  SKXI'AL    IMI'OTKNCK. 

K\. •.  continue  unpunished,  most  of  them  meeting  -with 
punislinionls  fur  less  severe  than  those  ordained  in  I  he 
penal  codes  of  the  above-mentioned  legislators. 

On  all  sides  and  at  all  limes  lias  it  been  cmplmsi/ed 
Ilial  nature  resents  every  infraction  of  her  laws.  This 
is  essentially  correct,  but  it  is  remarkable  that  most  of 
the  authors  look  upon  such  infraction  as  equivalent  to 
excess  only,  and  few  of  them  state  that  not  excessive  in- 
dulgence alone  but  also  excessive  continence  can  harm 
the  body  and  the  sexual  power.  An  explanation  of  this 
omission  is  chiefly  to  be  found  in  the  fact  that  real  conti- 
nence is  practised  so  seldom.  It  is  well  enough  to  exalt 
absolute  continence,  but  its  great  rarity  makes  talking  of 
it  a  positive  waste  of  time.  Thus  I  have  no  great  faith 
in  absolute  continence,  and  believe  the  continent,  with 
very  few  exceptions,  to  be  onanists.  Accordingly,  I  do  not 
wish  to  speak  of  absolute,  but  only  of  relative,  continence. 

In  theory  it  will  be  easy  to  understand  that  sexual 
faculties  not  kept  in  sufficient  practice  are  weakened 
thereby,  and  this  for  several  reasons.  Every  gland,  and 
consequently  also  the  sexual  glands,  requires  a  certain 
amount  of  excitation  of  its  nerves  in  order  to  produce 
energetic  action.  Every  muscle,  and  consequently  also 
the  muscles  of  erection,  can  become  strengthened  only 
by  exercise.  All  bodily  functions  demand  appropriate 
gymnastics,  the  sexual  functions  no  less  than  any  other. 
It  is  quite  noteworthy  that  authors  even  in  our  time  are 
rather  loath  to  advance  these  truths,  and  they  forget,  in 
some  measure  that "  continued  inactivity  of  nerves  dimin- 
ishes their  irritability  even  to  annihilation."  l 


1  Landois,  Lehrbuch  der  Physiologic  des  Menschen.     Wien  und 
,  1893,  p.  674. 


FORMS   OF  IMPOTENCE.  189 

A  robust  man  with  well-developed  virility  and  power- 
ful sexual  instincts  will  never  be  in  danger  of  making  too 
sparing  a  use  of  his  procreative  power,  at  least  not  vol- 
untarily. Such  is  more  likely  to  occur  with  people  who 
are  originally  poorly  provided  with  sexual  strength  and 
desires  ;  and  these  are  the  very  ones  who  cannot  afford 
to  do  without  reasonable  gymnastics  in  sexualibus,  just 
as  weakly  children  require  bodily  gymnastics  more  than 
stronger  ones  do.  Lallemand  *  expresses  this  very  ap- 
propriately when  he  says,  "No  one  will  think  that  a 
delicate  child  ought  to  be  kept  from  gymnastics  because 
it  shows  in  comparison  with  its  comrades  less  inclination 
and  aptitude  for  all  kinds  of  bodily  exercises." 

Since  the  sexual  power  plays  such  an  important  role 
in  human  life,  it  would  seem  natural  that  some  efforts 
should  be  made  to  strengthen  it.  We  are  yet,  however, 
at  a  great  distance  from  practical  and  unprejudiced 
views. 

It  is  practically  proven  that  continence,  whether  abso- 
lute or  relative,  induces  a  weakening  of  virility.  This 
fact,  which  is  in  accord  with  theory  and  proven  by  prac- 
tice, may  seem  to  contradict  the  very  common  experi- 
ence that  powers  injured  by  sexual  excesses  recover 
during  continence.  This  contradiction,  however,  is 
merely  apparent,  because  in  impotence  resulting  from 
sexual  excesses  the  cause  is  not  in  the  diminished  secre- 
tion of  the  sexual  glands  or  in  a  lowered  capacity  of  the 
muscles,  but  in  the  temporarily  weakened  state  of  the 
nerves.  During  moderate  continence  the  over-strained 
nerves  and  their  centers  have  the  necessary  time  to  be- 
come calmed  and  strengthened  ;  the  glands  and  muscles 

1  Pertes  seminales,  tome  ii.  p.  255. 


I'M)  SKXITAL    IMI'OTKM'K. 

cannot  be  injured   in   their  capacity  for  action   during  a 
time  of  rest  that  is  of  only  short   duration.     Continence 
is  certainly  not  of  equal  importance  with  sexual  exces 
nut  because  it  is  less  pernicious,  hut  because  of  its  greater 
rarity. 

The  commonest  consequence  of  absolute  or  relative 
continence  is  weakening  of  virility.  Sometimes  this 
weakening  is -preceded  by  a  stage  of  great  irritability  of 
the  sexual  organs,  during  which  too  frequent  pollutions 
may  set  in  and  become  permanent.  Thus  nature  helps 
itself,  but,  of  course,  not  without  injuring  the  organism 
in  another  direction  or  way,  since  pollutions  are  never 
unattended  by  pernicious  consequences.  In  general,  the 
sexual  instinct  disappears  gradually  if  not  roused  from 
without. 

Absolute  continence  is  so  seldom  the  object  of  medical 
observation  that  we  cannot  say  anything  definite  about 
the  phenomena  accompanying  it.  In  this  we  also  find 
the  only  explanation  for  the  song  that  Acton  sings  in 
praise  of  continence.  As  to  those  who  are  approximately 
continent,  daily  experience  informs  us  that  they  are.  sel- 
dom endowed  with  marked  virile  power,  and  I  believe 
that  they  are  naturally  possessed  of  a  low  degree  of  sex- 
ual power,  because  a  duly  gifted  man  neither  will  nor  can 
be  continent.  Weakness  and  incapacity  are  sometimes 
arrayed  in  the  garment  of  virtue.  "  In  any  case  there  is 
a  close  connection  between  the  activity  of  the  generative 
glands  in  a  pubescent  individual  and  the  degree  of  his 
libido." '  Nowadays  there  are  probably  few  who  still 
believe  the  obsolete  fable  that  sperm  once  secreted  can  be 
reabsorbed  and  then  be  of  special  benefit  to  the  body. 

1  Krafft-Ebing,  Psychopathia  sexualis.     Stuttgart,  1886,  p.  30. 


FORMS   OF   IMPOTENCE.  191 

Elsewhere  we  have  already  stated,  as  far  as  our  knowl- 
edge extends,  what  the  internal  processes  during  conti- 
nence are,  and  what  becomes  of  the  sperm  stored  up  in 
the  glands  that  prepare  it. 

The  cases  that  are  oftenest  observed  and  that  afford 
the  clearest  proofs  of  the  weakening  influence  that  con- 
tinence exercises  upon  virility  are  those  in  which  robust 
men  are  compelled  to  observe  continence.  In  this  res]  >ccl 
I  have  been  particularly  favored  by  having  the  opportu- 
nity of  making  my  observations  during  the  partial  mobil- 
ization of  (he  Austrian  army  when  a  part  of  it  was  for  a 
time  stationed  in  Bosnia.  Nearly  all  the  officers,  friends 
of  mine,  vigorous  young  men,  told  me  that  at  first  it  was 
hard  to  submit  to  the  abstinence  forced  upon  them  by 
the  social  circumstances  ;  but  after  a  time  it  was  compar- 
atively easy  to  bear.  Even  the  young  gentlemen  were 
not  surprised  at  their  ability  to  abstain,  but  their  aston- 
ishment followed  soon  when  one  or  another  obtained 
leave  of  absence  and  expected  to  do  wonders  when  at 
home.  Instead,  he  had  rather  to  remain  on  the  defen- 
sive at  first,  at  least,  until  the  novel  excitations  had  again 
animated  his  sexual  organs  to  new  activity. 

Edward  Martin1  mentions  prolonged  continence  as  one 
of  the  causes  of  atonic  impotence  in  cases  where  the 
instinct  is  strong  and  where  the  mind  has  long  been 
given  up  to  amorous  desires.  This  author  thinks  the 
reason  for  it  lies  in  the  "  prolonged  congestion  which 
does  not  receive  its  normal  physiological  relief."  The 
same  author  states  further  that  "  in  some  cases  the  organ 
is  so  poorly  developed  that  a  successful  intercourse  is 

1  Impotence  and  Sterility.  Hare,  System  of  Practical  Therapeu- 
tics. Philadelphia,  1882,  vol.  iii.  pp.  661-663. 


SEXUAL 

w.'ll-nigh  impossible.  This  is  generally  observed  in 
those  who  have  been  continent.  In  such  cases  local 
exercise  may  act  as  beneficially  as  it  docs  upon  other 
parts  of  the  body." 

Having  now  discussed  the  more  frequent  causes  of 
neurasthenic  impotence,  we  shall  treat  separately  a  lew 
of  the  more  prominent  forms. 

All  kinds  of  sexual  excess  lead  frequently  to  the  dif- 
ferent grades  of  paralytic  impotence.  Complete  paralysis 
of  the  sexual  nerves  and  centra  occurs  probably  rather 
seldom  as  long  as  the  rest  of  the  body  keeps  healthy  and 
robust.  In  senile  impotence  it  is  constant.  More  fre- 
quently we  notice  the  other  numerous  forms  of  sexual 
neurasthenia,  every  one  of  which  may  pass  over  into 
paralytic  impotence. 

In  the  first  instance  we  have  the  so-called  irritable 
weakness,  which  is  on  the  confines  between  diurnal 
pollutions  and  sexual  neurasthenia,  but  differs  from 
morbid  pollutions  chiefly  by  the  absence  of  any  material 
change  in  the  sexual  organs.  The  irritable  weakness 
consists  in  a  sexual  irritation  which  is  generally  of  a 
high  degree,  but  with  which  erection  does  not  keep 
pace,  for  erection  is  either  incomplete  to  start  with  or 
it  becomes  complete  only  after  long  exertions.  In  either 
case,  however,  the  ejaculation  is  precipitate  and  occurs 
even  before  the  introduction  of  the  penis  into  the  vagina, 
in  case  the  disease  is  high-graded.  This  disease  must 
not  be  confused  with  a  precipitate  ejaculation  with  in- 
complete erection  that  may  occur  quite  normally  with 
most  men  after  an  unusual  abstinence. 

We  need  not  add  anything  about  the  disagreeableness 
of  this  disease,  but  it  is  the  clearest  proof  of  the  incor- 
rectness of  the  assertion  that  the  pleasure  lies  in  the 


FORMS  OF  IMPOTENCE.  193 

ejaculation  alone,  which  opinion  has  been  shared  and 
upheld  by  many  authors.  Premature  or  precipitate 
ejaculation  deprives  the  man,  and  still  more  the  woman, 
of  the  due  pleasure ;  it  may,  moreover,  be  an  obstacle 
to  conception,  because  with  the  few  motions  of  coition, 
or  even  their  entire  absence,  there  is  no  orgasm  caused 
in  I  lie  woman,  this  being  generally  a  condition  essential 
to  conception. 

If  the  precipitate  ejaculation  is  caused  by  disease  of 
the  ductus  ejaculatorii  or  of  the  colliculus  seminalis,  it 
remains  constant  and  repeats  itself  without  exception  at 
every  coition.  If  the  precipitate  ejaculation  is  based 
upon  irritable  weakness  as  a  form  of  sexual  neuras- 
thenia, then  it  is  varying  like  all  other  neurasthenic 
diseases.  The  ejaculation  may  then  take  place,  at  one 
time  before  the  penis  enters  the  vagina ;  at  another  time 
it  may  occur  after  a  few  movements ;  again,  the  coitus 
may  be  accomplished  quite  normally,  and  at  some  other 
time  ejaculation  may  even  be  delayed. 

In  purely  neurasthenic  cases  of  irritable  weakness  we 
shall  not  find  that  high-graded  erethism  of  the  urethra 
which  Ultzmann1  speaks  of,  and  which  can  always  be 
noticed  when  the  "irritable  weakness"  is  caused  by 
material  changes  about  the  colliculus  seminalis. 

There  are  neurasthenic  individuals  who  have  precipi- 
tate ejaculations  with  one  woman,  though  they  can  have 
quite  normal  coitions  with  other  women.  Most  neuras- 
thenic persons  with  difficulty  get  over  the  first  attempts 
at  coition  with  a  new  acquaintance  ;  these  are  generally 
unsuccessful  attempts.  Such  men  must  first  get  ac- 


1  Potentia  generundi  und  Potentia  caeundi.    Wiener  Klinik,  1885, 
Heft  1,  p.  25. 

13 


I«i|  SKXTTAL  TMPOTKXCI'. 

enslmned  lo  their  new  acquaintance.    Their  very  vivid 

imagination  must  first  be  somewhat  pacified;  then  they 
recover  their  normal  condition  for  the  time  they  keep 
company  with  that  same  woman.  This,  however,  is  not 
lasting  with  most  neurasthenic  patients,  because  they 
soon  conceive  an  aversion  for  the  woman  in  question, 
and  their  disease  is  thus  the  cause  of  their  inconstancy. 

The  irritable  weakness  attended  by  material  changes 
in  the  sexual  apparatus  should,  in  my  opinion,  be  classed 
rather  with  morbid  pollutions.  It  has  its  cause  nearly 
always  in  excessive  onanism.  Such  individuals,  besides, 
suffer  almost  without  exception  from  frequent  pollutions. 

Excessive  onanism,  pollutions,  sometimes  onanism 
habitual  though  not  excessive,  are  in  like  manner  capa- 
ble of  causing  neurasthenic  irritable  weakness.  It  is 
not  onanism  exclusively  that  causes  this  form  of  disease. 
Sometimes  a  congenital  predisposition  to  neurasthenia, 
or  other  neurasthenic  disorders,  cause  temporary  or 
permanent  irritable  weakness.  At  other  times  the  cause 
may  be  mental  onanism  and  excitement  immediately 
preceding  coition.  There  are,  besides,  single  forms  of 
irritable  weakness  that  originate  in  or  arise  from  an 
over-sensitiveness  of  the  glans  ;  this  is  the  case  especially 
with  an  individual  whose  glans  is  wholly  covered  by  a 
prepuce  which  can  be  retracted  with  moderate  effort, 
and  the  glans  is  exceedingly  sensitive  when  it  has  thus 
been  laid  bare. 

When  considering  and  estimating  such  conditions,  it 
must  not  be  forgotten  that  whenever  there  are  signs  of 
increased  irritability  of  the  nerves,  we  are  nearly  always 
in  the  presence  of  the  first  stages  of  deterioration  of 
nerve  energy.  From  all  the  above  circumstances  we 
'must  infer  that  it  is  not  true  that  all  forms  of  impotence 


FORMS  OF  IMPOTENCE.  195 

through  irritable  weakness  are  "  spinopherous  or  pre- 
ponderantly spinal."  * 

A  rather  common  form  of  impotence  is  that  kind  of 
sexual  neurasthenia  which  is  generally  called  psychical 
impotence,  which  might  with  more  propriety  be  named 
hypochondriac  impotence.  We  very  seldom  see  a  purely 
psychical  impotence  in  which  the  sexual  organs  and 
their  connection  with  the  central  organ,  as  well  as  the 
entire  nervous  system,  are  perfectly  sound.  There  may 
be  very  impressionable  individuals  who  are  apparently 
healthy  in  every  respect,  and  yet  may  become  tempo- 
rarily impotent  simply  by  the  effect  of  the  thought  that 
they  are  impotent,  or  by  the  fear  of  not  being  able  to 
irivr  satisfaction  in  a  certain  case.  Such  individuals  are 
evidently  healthy  in  appearance  only ;  but,  like  a  hypo- 
chondriac who  suffers  from  an  evil  that  is  real,  though 
he  magnifies  it,  so  also  is  the  psychically  impotent  man 
afflicted  with  some  organic  defect  which  is  not  discov- 
ered until  he  is  examined  with  care.  Then  it  is  found 
without  exception  that  these  are  neurasthenics  suffering 
from  psychical  impotence,  and  are  generally  people  who 
have  weakened  their  sexual  organs  and  burdened  their 
conscience  through  onanism  or  some  other  mismanage- 
ment of  their  sexual  power.  They  need  intense  excite- 
ment to  obtain  an  erection  necessary  for  coitus.  Their 
centers  of  erection  must  be  blunted  and  their  inhibitory 
centers  just  as  sensitive,  since  a  mere  thought  is  often 
sufficient  to  excite  the  latter  and  paralyze  the  former. 

In  psychical  impotence  it  must  further  be  remembered 
that  every  thought  likely  to  divert  the  mind  from  the  act 
in  contemplation  can  also  prevent  erection  altogether  or 

1  Eulenburg,  Sexuale  Neuropathie.     Leipzig,  1895,  p.  28. 


lOfi  SEXTAI,    IMI'OTK.NCK. 

overcome  it  if  already  begun.  Hence  it  is  a  matter  of 
course  that  anxiety,  fear,  shame,  or  any  other  feeling  that 
may  engage  the  mind  cannot  be  favorable  to  erection ;  and 
tin'  thought  alone  that  one  may  not  be  able  to  accom- 
plish coitus  can  become  a  hindrance  to  erection.  Neuras- 
thenic patients,  also  described  under  the  name  of  hypo- 
chondriacs, are  not  very  capable  in  matters  of  sexual 
functions  on  account  of  their  ever-present  ill  humor  and 
anxiety. 

It  would  be  a  great  error  if  we  were  to  assume  that 
only  weakly  and  sickly  persons  can  be  affected  with 
psychical  impotence.  We  see  often  enougn  quite  robust 
and  vigorous  men  subject  to  occasional  attacks  of  psychi- 
cal impotence.  It  renders  them  exceedingly  miserable  ; 
they  cannot  get  rid  of  the  idea  that  they  are  impotent, 
and  in  the  end  positively  become  so,  if  some  incident  or 
sensible  advice  does  not  convince  them  to  the  contrary. 

The  phenomena  of  psychical  impotence  are  manifold 
and  variable.  We  could  not  expect  that  it  would  be 
otherwise  in  any  neurasthenic  disease.  At  one  time  the 
patient  may  have  vigorous  erections,  but  they  come  at 
the  wrong  time  ;  then,  when  the  occasion  presents  itself, 
there  arrives  instead  of  the  erection  the  thought  of  the 
impossibility  of  the  accomplishment  of  coitus.  At  an- 
other time  the  erection  is  there  when  wanted,  but  fades 
gradually  as  the  patient  proceeds  to  the  act,  or  at  the  first 
movements.  Quite  remarkable  is  the  circumstance  that 
this  form  of  impotence  may  also  affect  quite  strong  and 
vigorous  individuals,  but  only  on  the  occasion  of  new 
sexual  connections. 

There  are  many  men,  and  I  am  inclined  to  include 
here  all  bon-vivants,  who  experience  great  difficulty  in 
accomplishing  a  first  coitus  with  any  woman.  It  is  re- 


FORMS  OF  IMPOTENCE.  197 

markable  that  in  this  disease — for  a  disease  it  most  cer- 
tainly is — a  man  may  feel  a  great  preference  for  a  woman, 
wish  most  ardently  sexual  union  with  her,  and  yet  remain 
impotent  when  in  her  arms ;  when,  on  the  other  hand, 
he  may,  on  leaving  her,  go  straight  to  an  undesirable 
woman  who  inspires  no  love,  and  accomplish  the  act 
without  the  least  difficulty,  and  even  repeat  it.  The 
only  reason  is  that  in  the  latter  case  old  acquaintance 
makes  him  feel  at  home  and  excludes  any  apprehension 
of  mishap.  The  cause  cannot  be  a  sense  of  too  intense 
love  or  reverence,  ban-vivants  not  often  being  influenced 
by  such  feelings. 

The  want  of  responsiveness  in  a  new  acquisition  has 
sometimes  a  disadvantageous  effect  on  the  man  ;  nearly 
always  it  is  the  apprehension  of  a  failure  that  makes  men 
who  are  generally  expert  impotent  for  the  time  being. 
To  this  is  added,  in  illegitimate  sexual  connections, 
the  chance  of  unfavorable  circumstances,  such  as  want  of 
time,  rest,  convenience,  and  responsiveness.  These  men 
generally  recover  their  former  vigor  perfectly  after  having 
(nice  succeeded  with  a  new  acquaintance,  and  they  then 
console  themselves  with  that  proverbial  German  say- 
ing that  nearly  always  proves  true,  "Aller  Aufang  ist 
schwer."  l  If  a  man  has  cohabited  for  a  long  time  with 
one  woman,  the  beginning  with  another  is  attended  with 
some  difficulty ;  hence  the  trouble  experienced  in  the 
first  matrimonial  infidelity,  which  often  drives  a  husband 
back  to  the  arms  of  his  better  half. 

Inexperienced  young  people  may  in  the  beginning  of 
matrimony  remain  psychically  impotent  for  some  time. 
This  inexperience  must,  however,  be  of  a  high  degree,  if 

1  "  The  difficulty  is  in  the  outset." 


198  SEXUAL  IMPOTENCE. 

a  mixed  form  of  impotence  is  not  at  the  bottom  of  the 
trouble.  Cases  of  impotence  caused  merely  by  inexperi- 
ence are  no  doubt  very  rare,  whatever  books  may  have 
to  say  on  the  subject.  Such  people  are  generally  young 
onanists,  or  they  may  have  grown  old  in  intercourse 
with  public  women  without  having  an  idea  of  proper 
coitus. 

In  this  great  variety  of  phenomena  of  neurasthenic 
diseases  it  will  not  be  surprising  if  still  other  forms  than 
the  ones  mentioned  present  themselves  for  observation. 
It  would  lead  us  too  far  if  we  should  attempt  to  enu- 
merate here  all  the  phenomena  of  sexual  neurasthenia. 
There  are  so  many  that  one  life  is  too  short  for  the 
study  or  observation  of  them  all.  You  may  fancy  you 
have  exhausted  the  subject  at  one  time,  and  yet  new 
varieties  crop  up :  there  is  no  end  of  them. 

We  shall  here  describe  but  two  more  groups  of  sexual 
neurasthenia.  These  are  generally  designated  as  tem- 
porary and  relative  impotence. 

By  the  expression  temporary  impotence  is  meant  a 
condition  in  consequence  of  which  a  man  may  within 
short  intervals  of  time  be  now  virile  and  now  impotent. 
The  individual  is  utterly  incapable  of  understanding  how 
he  became  impotent,  as  only  a  few  days  ago  he  had  all 
the  necessary  virile  power.  He  now  searches  after  every 
and  any  possible  cause,  and  accuses  liquors,  tobacco, 
physical  and  mental  exertions,  etc.  Of  course,  we  leave 
out  of  question  here  that  temporary  impotence  which 
visits  particular  individuals  after  the  commission  of  sex- 
ual excesses,  as  it  is  in  the  nature  of  things  that  the 
energy  of  the  sexual  impulse  is  in  an  even  proportion  to 
the  provision  of  spermatic  fluid  on  one  hand,  and  with 
the  stored- up  energy  and  elasticity  of  the  nerves  on  the 


FORMS  OF  IMPOTENCE.  199 

other.     The  proportion  is  even  up  to  a  certain  degree  ; 
beyond  that  it  becomes  reversed. 

With  man  the  sexual  instinct  luckily  does  not  make 
its  appearance  periodically,  as  it  does  with  animals.  Most 
authors  assert  that  in  spring  it  is  most  intense,  and  prove 
this  assertion  by  lists  of  births  with  their  dates. 

Persons  who  are  affected  by  intermittent  impotence 
are  generally  sexually  excited  in  a  high  degree,  and  most 
so  when  they  are  in  a  stage  of  impotence.  This  sexual 
excitement  is  not  a  real  orgasmus  venereus,  always  lead- 
ing to  an  erection  ;  but  rather  a  state  of  agitation  caused 
by  mental  onanism,  a  debauchery  of  the  thoughts,  as 
Lallemand  calls  it,  "  Licentiousness  in  thought  which  is 
in  marked  contrast  to  the  impotency  of  the  executive 
organs."  The  more  agitated  such  a  patient  is,  the  more 
his  penis  shrinks,  the  less  he  is  capable  of  copulation. 
Then,  all  of  a  sudden,  when  the  sufferer  has  resigned 
himself  to  inaction,  erection  appears  and  coition  may  be 
performed,  and  sometimes  even  repeated.  This  form  of 
transitory  impotence  may  also  come  to  quite  healthy 
individuals  during  great  agitation. 

Relative  impotence  designates  in  general  a  condition 
in  which  an  individual  can  accomplish  coition  only  with 
one  or  certain  mates,  and  is  completely  impotent  with 
others  ;  or  a  condition  in  which  an  individual  cannot 
accomplish  coition  with  one  or  certain  women,  and  is 
perfectly  virile  with  others. 

Strictly  speaking,  there  are  few  persons  who  are  not 
relatively  impotent,  for  only  few  can  accomplish  the  act 
with  all  persons.  In  the  same  way  the  stomach  may 
revolt  against  certain  things ;  so  may  the  nose.  The 
specific  odor  of  one  person  may  be  absolutely  objection- 
able to  another.  The  difference  in  the  chemical  elabora- 


200  SEXUAL   IMPOTENCE. 

tion  in  different  individuals  imparts  a  certain  odor  to  the 
whole  body,  and  also  to  separate  parts  of  it.  This  may 
often  be  the  cause  of  sympathy  or  antipathy  between  per- 
sons of  different  sex.  This  state  is  to  be  called  morbid 
only  when  a  man  is  incapable  of  accomplishing  coition 
with  a  certain  woman,  although  he  is  desirous  of  doing 
so,  and  has  a  liking  for  her. 

We  read  in  older  works  on  impotence — and  many 
modern  ones  have  copied  from  them — various  miracu- 
lous stories  of  how  excessive  love,  a  state  of  rapture  of 
a  high  degree,  has  rendered  the  poor  lover  impotent. 
French  authors  particularly  exhibit  a  very  poetical  con- 
ception of  this  state.1  Such  stories  cannot,  I  suppose, 
be  relegated  altogether  to  the  realm  of  myth,  but  occur, 
no  doubt,  very  seldom,  such  a  state  of  agitation,  not 
at  all  in  accord  with  our  modern  way  of  feeling,  being 
generally  of  so  short  duration  that  no  assistance  of  the 
medical  art  is  required. 

The  case  is  very  different  with  regard  to  feelings  that 
are  the  opposite  to  those  of  love,  as  aversion  or  even 
hate.  These  are  not  of  a  nature  to  inspire  a  man  with 
amorous  lusts  by  the  side  of  the  object  of  abhorrence. 
We  are  more  particularly  interested  in  cases  where  these 
extreme  feelings  are  not  active. 

There  are  many  husbands  who  are  impotent  out  of 
wedlock.  With  most  of  these  gentlemen  virility  has  not 
been  duly  developed  to  begin  with.  With  many  it  is  a 
kind  of  depravity  and  habitual  pampering  that  has  ren- 
dered them  thus,  and  they  would  be  perfectly  virile  out 
of  wedlock,  if  time  and  circumstances  in  regard  to  other 
women  were  analogous.  It  is  a  similar  sort  of  depravity 

1  Roubaud,  op.  cit.,  p.  377. 


FORMS  OF  IMPOTENCE.  201 

if  a  man  can  accomplish  coition  only  in  certain  positions 
or  after  certain  preparations.  Among  old  bachelors,  who 
pluck  forbidden  fruit  only,  there  are  some  who  must 
always  have  their  lady-loves  in  full  dress. 

After  all,  there  is  certainly  no  harm  in  a  husband's 
impotence  outside  of  wedlock.  It  is  rather  preferable 
for  both  himself  and  his  better  half;  but  it  is  a  very  dif- 
ferent case  when  a  husband  is  impotent  with  his  legiti- 
mate wife.  This,  Ultzmann l  asserts,  is  a  very  disagreeable 
affair.  Such  relative  impotence  may  exist  from  the  very 
beginning  of  matrimony,  or  it  may  arise  in  the  course  of 
time.  At  the  beginning  of  matrimony  it  never  occurs  in 
what  we  commonly  call  love-marriages,  and  only  seldom 
in  marriages  of  convenience.  Occasionally  the  personal 
odor  of  a  woman  may  be  disagreeable  to  a  man,  "  le 
parfum  d'une  femme"  (Galopin).  This  may  go  so  far  as 
to  prevent  erection.  In  such  a  case,  sound  reason  would 
demand  neither  more  nor  less  than  a  divorce. 

In  the  course  of  matrimony  psychical  and  physical 
differences  arise  between  husband  and  wife,  especially 
in  cases  where  the  wife  ages  before  the  husband,  these 
differences  often  inducing  a  relative  impotence.  Some- 
times the  cause  of  such  relative  impotence  is  in  the  cir- 
cumstance that  the  husband  has  entered  upon  extra- 
matrimonial  relations,  which  seem  to  him  preferable,  so 
that  his  enjoyment  at  home  diminishes.  All  these  are 
cases  where  the  physician  may  have  advice  to  offer,  but 
no  help. 

There  are  cases,  however,  where  the  wife  may  be 
wanting  in  her  duties  toward  the  husband.  She  may 
not  be  sufficiently  responsive,  or  she  may  have  a  repug- 

1  Op.  cit.,  p.  25. 


202  SEXUAL  IMPOTENCE. 

nance  for  sexual  intercourse.  Enjoyments  not  shared 
aiv  in  srxualibus  less  than  half-pleasures.  Thus,  Hie 
husband  feels  less  and  less  desire  to  repeat  fruitless 
efforts,  and  looks  elsewhere  for  indemnification. 

PROFESSIONAL    IMPOTENCE. 
"  Desidiam  puer  ille  sequi  solet ;  odit  agentes." — OVID. 

That  vocation  may  have  great  influence  on  the  sexual 
power  of  a  man  was  known  to  the  ancient  hygienic 
legislators,  as  Moses,  Mohammed,  etc.  In  this  respect 
certain  vocations  stand  in  bad  renown,  and  especially 
those  which  require  principally  mental  exertion. 

In  general  we  find  the  notion  widely  spread  that  the 
higher  an  individual  stands  intellectually,  the  less  will 
be  his  capacity  for  sexual  functions.  La  Fontaine's  "  un 
muletier  a  ce  jeu  vaut  trois  rois"  has  passed  from  the 
French  books  into  the  Italian.  In  my  opinion  this  almost 
proverbial  saying  is  not  quite  in  accord  with  the  truth. 
I  admit  that  for  a  short  time  the  victory  may  remain 
with  the  "  muletier,"  but  after  a  certain  time  the  brutish 
instincts  of  the  "  muletier1'  will  be  appeased,  his  fantasy 
will  not  be  able  to  take  the  place  of  the  real  wants,  and 
then  the  "  roi"  will  undoubtedly  be  the  better  man. 

There  is  no  doubt  that  in  sexualibus  the  intellectual 
man  stands  above  the  peasant,  for  instance.  Any  one 
who  has  an  opportunity  to  watch  these  country  people 
in  their  hymeneal  life  will  soon  discover  that,  although 
the  peasant  may  perform  extraordinary  feats  at  first  dur- 
ing his  matrimonial  life,  he,  nevertheless,  later  on  grows 
very  neglectful  in  his  conjugal  duties.  Of  course,  the 
hard  work  brings  here  physical  fatigue,  and  there  is  little 
imagination  at  work.  Again,  the  attractiveness  of  these 
honest  countrywomen  diminishes  rapidly. 


FORMS  OF  IMPOTENCE.  203 

Heavy  bodily  work  bringing  about  bodily  fatigue,  and 
intense  mental  exertion  causing  mental  fatigue,  are  not 
favorable  for  the  sexual  power  of  man.  Entire  inactivity 
would  be  favorable,  it  is  true,  if  we  mortal  beings  did 
not  grow  weary  in  the  dolce  il  far  niente,  which  soon 
leads  to  devious  roads  and  to  excesses  which  then  un- 
dermine sexual  vigor.  Those  occupations  in  which  labor 
is  performed  without  fatigue  and  accompanied  by  a  cer- 
tain amount  of  mental  exercise,  and  those  mental  occu- 
pations that  are  relieved  by  the  requisite  amount  of 
physical  exercise,  are  the  callings  that  present  the  most 
vigorous  men. 

The  Talmud  treated  the  members  of  the  learned  pro- 
fessions to  an  exceptional  favor  by  granting  them  the 
privilege  of  intercourse  with  their  wives  once  in  two  or 
three  years,  while  the  wives  of  others  had  a  legitimate 
claim  upon  their  husbands  at  least  once  a  week.  Book- 
worms are  generally  weak  in  sexualibus,  as  has  been 
known  for  thousands  of  years.  Many  a  one  may,  like 
Rousseau,  have  received  from  some  experienced  lady 
the  confidential  advice,  "  lascia  le  donne,  e  studia  la 
matamatica,1'  without  making  so  much  ado  about  it. 
Part  of  the  cause  is  in  the  sedentary  life  of  these  men, 
which  is  not  conducive  to  health ;  and  part  is  in  the 
over-exertion  of  the  brain,  that  is  apt  in  the  course  of 
time  to  aggravate  the  neurasthenia  which  exists  often 
<i  jn-iori  with  men  who  are  inclined  to  mental  efforts. 
This,  then,  will  in  the  end  bring  about  a  new  diminution 
of  the  sexual  power.  Besides,  intense  mental  activity 
exercises  the  thinking  parts  of  the  central  nervous 
system  to  the  detriment  of  the  sensitive  and  motor 
parts. 

If  artists  and  scliolars,  as   painters,  actors,  authors, 


204  SKXIM.    I  \iroTK\CK. 

physicians,  professors,  etc.,  are  sometimes  reported  to  he 
not  disinclined  to  love,  or  to  be  sensual,  this  is  no  proof 
of  the  contrary,  because  the  presence  of  sensuality  docs 
not  imply  that  of  sexual  strength. 

Withal,  we  see  that  highly  intellectual  and  learned 
men  are  often  possessed  of  a  considerable  wealth  of 
children,  so  that  NordauV  dictum,  "From  common 
men  we  obtain  the  conservation,  from  great  minds  the 
intellectual  advancement,  of  our  species.  The  same 
individual  cannot  be  equally  capable  of  producing  both 
thought  and  children,"  merely  repeats  a  popular  dictum 
not  supported  by  fact.  The  best  thought  has  come  from 
people  who  have  also  produced  children  ;  while  but  few 
impotent  men  can  console  themselves  with  the  fancy 
that  their  weakness  has  not  prevented  them  from  pro- 
ducing at  least  good  thought. 

Some  authors  advance  the  idea  that  people  who  attach 
great  importance  to  an  excellent  table,  the  so-called  epi- 
cures, possess  but  little  sexual  impulse.  For  my  part  I 
must  state  that  I  have  observed  the  opposite  condition 
only, — the  so-called  great  eaters  are  also  great  worship- 
pers of  the  fair  sex  until  the  time  when  the  superflu- 
ous quantity  of  nourishment  induces  obesity,  and  obesity 
grows  from  day  to  day  more  hostile  to  Venus. 

In  all  ranks  and  conditions  of  life  there  are  to  be 
found  people  with  extraordinary  virility,  and  others  with 
weak  sexual  power.  It  is  a  matter  of  course  that  people 
who  are  preoccupied  by  cares,  ambition,  or  any  other 
unusually  absorbing  state  of  mind,  have  little  time  to 
spare  for  love  and  sexual  affairs.  They  consequently 

1  Max  Nordau,  Die  conventionellen  Liigen.  Leipzig,  1886,  12 
Auflage,  p.  123. 


FORMS   OF   IMPOTENCE.  205 

have  a  weaker  sexual  impulse  than  others  who  devote 
a  great  part  or  even  the  whole  of  their  time  to  ponder- 
ing over  sexual  matters.  This  is  the  reason  why  great 
workers,  whether  physical  or  mental,  endure  sexual  ab- 
stinence very  easily ;  but  only  in  case  they  have  been 
abstinent  to  begin  with.  Scholars,  for  instance,  who  have 
only  in  the  course  of  time  taken  to  study,  cannot  stand 
absolute  continence  even  during  uninterrupted  study. 
They  are  seized  writh  vertigo  and  uneasiness  in  the  midst 
of  the  most  intense  mental  efforts,  these  evils  not  abating 
until  sexual  satisfaction  has  been  obtained.  I  have  had 
occasion  to  watch  more  than  one  case  of  this  nature,  and 
the  patients  have  always  experienced  good  results  by  fol- 
lowing my  advice, — viz.,  to  give  up  absolute  abstinence. 
Finally,  I  must  once  more  refer  here  to  the  notion 
that  has  descended  from  Hippocrates  to  Lallemand 
and  Roubaud.  In  spite  of  Hippocrates  and  his  fol- 
lowers, I  repeat  that  rid'nnj  cannot  exercise  an  inju- 
rious influence  on  the  sexual  power.  A  single  glance 
gi  VCM  to  cavalry  will  convince  to  the  contrary.  Not  to 
mention  my  own  experience  with  cavalries  of  different 
countries,  I  will  point  to  the  fact  that  where  horse- 
iv, i  ring  is  carried  on  and  horseback-riding  is  very  com- 
mon the  number  of  births,  both  legitimate  and  others,  is 
rather  above  the  average,  and  the  morality  of  such  places 
is  somewhat  light.  In  consideration  of  all  this  it  is  ob- 
vious that  riding  is  no  hindrance  to  the  development  of 
the  sexual  power. 

SENILE    IMPOTENCE. 

The  energy  of  the  bodily  functions  diminishes  with 
the  advance  of  age.  The  sexual  function,  being  one  of 
the  last  in  its  development,  is  also  the  first  usually  in 
the  file  of  the  functions  that  gradually  desert  the  body, 


200  SEXUAL   IMI'OTK.MT, 

Crowing  by  decrees  weaker.  Old  men  consequently  are 
impotent  according  to  the  course  of  nature,  and  yd 
I lii-re  are  very  old  persons  who  can  still  accomplish 
something  remarkable  in  sexualibus. 

We  most  admit  a  difference  in  old  people,  considering 
more  the  condition  of  the  body  than  the  number  of 
yi-ars.  Appearance  alone  often  deceives,  as  we  may  see 
old  persons  whose  bodies  have  preserved  all  their  forces 
but  the  sexual.  The  reverse  is  hardly  ever  seen,  wilh 
the  exception  of  those  pathological  cases  where  in 
decrepit  old  men  there  is  a  sexual  impulse  quite  out  of 
proportion.  There  are  perfectly  vigorous  old  men,  as 
there  are  also  quite  decrepit  young  people.  Every  physi- 
cian has  opportunities  of  observing  men  of  seventy  or 
more  years  who  possess' excellent  power  of  assimilation 
of  material  and  also  quite  energetic  sexual  functions. 

The  autopsies  of  old  men  made  by  Duplay,  Dieu,  and 
others  show  that  even  octogenarians  may  have  u-dl- 
d<  r</<,j,</l  xjK'rmatozoa,  which,  however,  does  not  prove 
that  they  are  virile,  but  only  that  they  may  be  so.  After 
all,  sexually  vigorous  old  men  are  exceptions,  because  the 
functional  capacity  of  the  sexual  organs  generally  begins 
to  diminish  with  the  fiftieth  year,  continuing  to  decrease 
until  the  sixty-fifth  year,  when  it  is  generally  extinct. 

As  the  greatest  iinlirnliKif  <7///ov//'r.s-  prevail  in  this 
respect,  it  is  quite  impossible  to  set  a  fixed  time  for  the 
beginning  of  physiological  senile  impotence.  Nor  is  it 
possible  to  determine  in  every  case  why  such  or  such 
an  individual  has  grown  impotent  in  early  life  while 
another  is  still  perfectly  vigorous  at  an  advanced  age. 
It  is  noticed  that  in  some  families  a  premature  impotence 
and  in  others  a  tardy  extinguishment  of  the  sexual  power 
is,  so  to  speak,  hereditary..  Some  individuals  who  have 


FORMS  OF  IMPOTENCE.  207 

been  healthy  and  strong  all  their  lives  remain  sexually 
vigorous  to  a  good  age.  Again,  other  individuals  are 
seen  who  have  always  used  with  prudence  their  sexual 
power  and  possess  otherwise  the  requisite  qualities,  pre- 
serving their  manhood  to  a  high  age.  Too  frequent 
excesses,  especially  in  onanism  in  youth,  and  over- 
ra  iv  ful  husbanding  of  the  sexual  power  are  the  greatest 
enemies  to  the  preservation  of  virility.  It  is  extin- 
guished earliest  in  individuals  in  whom  it  has  never 
appeared  with  impetuosity,  and  who,  on  account  of  this 
feeble  desire,  have  acquired  renown  for  virtuousness. 
It  disappears  latest  in  those  who  may  now  and  then 
have  given  rein  to  their  impetuous  impulse,  but  without 
going  in  their  enjoyment  beyond  a  reasonable  measure, 
— who  have,  in  a  word,  given  off  at  all  times  only  what 
they  could  easily  spare. 

Only  a  superficial  observer  will  be  surprised  at  seeing 
one  individual  quite  impotent  when  old,  after  having 
solicitously  spared  his  sexual  power  all  his  life,  and 
another,  known  as  an  epicurean,  who  still  possesses  a 
certain  degree  of  sexual  vigor  in  spite  of  his  advanced 
age.  Medical  science  must  not  be  unfair  toward  such 
exceptions,  which  are  frequent  enough.  It  must  not 
thoughtlessly  follow  the  dictum  of  the  past,  and  deny 
them  every  sexual  power,  together  with  the  right  to 
make  use  of  it.  I  am  aware  that  these  old  veterans 
will  not  care  for  the  well-intended  but  strict  prohibi- 
tions of  too  scrupulous  medical  authorities.  I  know 
they  will,  all  the  same,  put  into  practice  their  right  as 
much  as  possible  and  feasible,  and  I  will  frankly  oppose 
my  opinion  to  those  scruples  and  say  that  old  people 
run  no  risk  in  satisfying  real  sexual  wants. 

Of  course,  I  am  not  including  here  those  pathological 


208  SKXT.M,    IMI'MTKNTK. 

rases  of  an  increased  or  reawakened  sexual  impulse  in 
old  age  after  it  had  become  extinct.  I  am  speaking  here 
only  of  preserved  sexual  vigor  in  advanced  age.  I  be- 
lieve Mi, if  satisfying  real  sexual  wants  can  be  but  advan- 
tageous to  old  age,  as  it  contributes  to  stimulate  the 
energy  in  the  assimilation  of  material;  it  buoys  up  and 
makes  the  heart  rejoice;  it  helps  to  keep  up  cheerful- 
ness, which  is  generally  reduced  in  old  people,  and 
therefore  may  properly  be  considered  as  a  means  of 
favoring  longevity. 

As  to  those  cases  in  which  death  occurred  soon  after 
some  old  gentlemen  had  entered  into  married  life,  or 
those  cases  of  sudden  death  before,  during,  or  after 
coition,  nothing  is  proved  by  them,  since  we  hear  every 
day  of  persons  dying  slowly  or  suddenly  without  having 
thought  of  marriage  or  of  sexual  intercourse  for  a  long 
time  past.  Again,  we  also  see  men  rejuvenated  by  the 
side  of  young  wives  and  living  to  an  advanced  age.  At 
any  rate,  those  old  men  who  are  still  in  possession  of  a 
good  remainder  of  their  sexual  power  have  a  better  pros- 
l» •< -I  of  a  long  life  than  those  who  in  a  decrepit  state  are 
condemned  to  a  virtue  which  is  not  always  voluntary. 

Modern  authors  are  beginning  to  conform  to  these 
ideas.  Edward  Martin,1  for  instance,  knows  "  of  one 
man  who  at  the  age  of  seventy-eight  has  begotten  a 
child,  and  who  states  that  his  erections  are  as  vigorous 
as  in  youth,  and  that  he  performs  the  sexual  act  fre- 
quently and  satisfactorily.  This  man's  powers  are  pos- 
sibly kept  alive  by  his  marriage  with  a  young  and 
vigorous  woman/1 


1  Impotence  and  Sterility.    Hare,  System  of  Practical  Therapeu- 
tics, vol.  iii.  p.  661. 


CHAPTER  VI. 
DIAGNOSIS. 

ALTHOUGH  the  causes  are  manifold,  yet  all  the  forms 
of  impotence  have  this  in  common,  that  the  diagnosis 
is  in  the  first  instance  based  upon  the  subjective  sensa- 
tions and  observations  of  the  patient  himself.  It  is  well 
known  how  unreliable  the  statements  of  patients  are. 
Objectively  there  is  very  little  to  discover  in  most  of  these 
forms ;  while  in  some  the  external  sexual  organs  show 
various  degrees  of  flaccidity,  shrinkage,  and  paleness. 
An  endoscopic  inspection  of  the  urethra  reveals  in  most 
cases  different  degrees  of  paleness  of  the  mucous  mem- 
brane, and  in  nearly  all  cases  that  are  associated  with 
involuntary  loss  of  sperm  various  degrees  of  inflamma- 
tion of  the  colliculus  seminalis  are  discovered.  Very 
often  the  result  of  such  inspection  is  negative. 

Although  these  few  points  of  diagnosis  are  of  small 
importance  and  are  not  always  present,  yet  the  physician 
must  never  fail  to  examine  minutely  the  sexual  organs 
with  the  endoscope  and  without  it,  because  the  positive 
or  negative  result  will  yield  some  points  in  eliciting  the 
causes  and  helping  to  determine  the  appropriate  treat- 
ment. The  objective  results,  whether  positive  or  nega- 
tive, together  with  the  statements  of  the  patient,  must 
then  form  a  whole,  from  which  the  physician  will  deduce 
his  opinion,  or,  relying  on  which,  he  will  engage  in  further 
investigations.  The  result  of  an  endoscopic  inspection 

14  209 


210  SEXUAL  IMPOTENCE. 

is  in  many  cases  very  important.  Unfortunately,  many 
persons  are  very  sensitive  to  the  use  of  an  endoscope, 
and  this  is  easy  to  understand  if  we  consider  that  they 
are  in  many  cases  neurasthenic  and  timorous.  Proper 
encouragement  and  confidence  in  the  result  will,  how- 
ever, persuade  the  impotent  to  submit  to  almost  any- 
thing. 

When  any  one  consults  me  upon  impotence,  I  usually 
begin  with  close  questioning ;  after  this  I  proceed  to  the 
inspection  of  the  exterior  of  the  whole  body,  and  par- 
ticularly of  the  sexual  organs.  This  is  followed  by  an 
endoscopic  examination,  and,  in  conclusion,  I  question 
the  patient  about  the  various  points  that  may  have  been 
observed  during  the  inspection. 

A  physician  on  the  point  of  engaging  in  some  treat- 
ment or  other  from  which  he  expects  any  satisfactory 
result  must  know  regarding  his  patient  the  age,  hered- 
itary conditions,  occupation,  constitution,  manner  of 
living,  previous  diseases  and  sexual  life,  present  state 
of  health,  and  every  detail  of  the  existing  degree  of 
impotence.  He  must,  besides,  subject  to  a  careful  exami- 
nation the  whole  body  of  his  patient,  and  especially  the 
genitals.  The  penis  as  well  as  the  testicles  and  sper- 
matic cords  must  be  examined  in  regard  to  size,  the 
amount  of  blood  they  contain,  and  their  sensitiveness. 
The  introduction  of  the  endoscope  will  indicate  at  once 
the  width  and  sensibility  of  the  urethra,  the  color  and 
other  conditions  of  the  urethra,  and  especially  of  the 
colliculus  seminalis. 

The  diagnosis  is  easy  in  most  forms  of  impotence,  but 
is  subject  to  frequent  mistakes  on  account  of  the  unre- 
liability of  the  statements  of  the  patient.  Modesty,  igno- 
rance, false  notions,  excessive  timidity,  and  an  inclination 


DIAGNOSIS.  211 

to  falsehood  are  the  commonest  causes  that  induce  a 
patient  to  make  many  a  wrong  statement  wittingly  or 
unwittingly. 

There  is  no  difficulty  in  the  diagnosis  of  congenital  or 
acquired  defects  in  the  formation  of  the  external  genitals. 
In  cases  where  the  congenital  defects  concern  the  inter- 
nal genitals,  without  any  outward  signs,  some  light  may 
be  thrown  upon  the  question  by  endoscopy  and  by  a 
microscopic  examination  of  the  sperm. 

In  impotence  following  some  disease  not  located  in  the 
region  of  the  genitals  the  diagnosis  of  the  primary  or 
causative  disease  is  sufficient  to  elicit  the  cause  of  the 
impotence,  and  then,  generally,  there  are  no  correspond- 
ing pathological  changes  about  the  genitals. 

In  some,  though  very  few,  cases  of  inherited  predispo- 
sition to  impotence  the  diagnosis  is  very  difficult,  because 
the  appearance  of  the  patient  and  also  the  condition  of 
the  visible  sexual  organs  seem  to  contradict  the  state- 
ments of  the  patient.  Again,  in  other  cases,  while  the 
external  genitalia  may  not  appear  to  correspond  to  the 
condition  of  the  rest  of  the  body,  no  sufficient  explana- 
tion is  presented  for  the  complete  impotence  that  ex- 
ists ;  hence  the  physician  must  depend  largely  upon  the 
statements  of  the  patient  for  a  diagnosis.  The  local 
temperature  and  electro-sensibility  are  in  such  cases  of 
particular  importance. 

In  the  neurasthenic  forms  of  impotence  resulting  from 
abuse  of  the  sexual  power  the  conditions  are  of  very 
varying  nature.  In  some  cases  there  is  absolutely  noth- 
ing to  be  established  objectively,  except  a  diminution  in 
the  sensibility  and  electrical  irritability.  In  other  cases, 
again,  we  find  abnormal  pallor  and  laxness  in  the  exter- 
nal sexual  organs,  with  or  without  local  inflammation  in 


212  SEXUAL  IMPOTENCE. 

the  ductus  ojaculatorii  and  neighboring  parts,  always  as- 
sociated willi  paleness  of  the  urethra.  Griinfcld1  stales 
that  in  onanists  he  found  hyperemia  of  the  colliculus 
seminalis  nearly  constant.  The  usual  signs  are  daik- 
rcd,  even  scarlet  color,  and  hypertrophy  associated  with 
slight  vulnerability  of  the  colliculus  seminalis.  In  SJHT- 
matorrhea  Griinfeld  found  catarrhal  swelling  of  the  col- 
liculus seminalis.  In  high-graded  spermatorrhea  accom- 
panied by  impotence  a  yellowish-red  coloring  takes  the 
place  of  the  reddening  of  the  mucous  membrane.  In 
individuals  suffering  from  pollutions  Griinfeld  found  in 
some  cases  a  kind  of  hypertrophy  of  the  colliculus  semi- 
nalis. Such  results  or  conditions  may  be  recorded 
by  every  endoscopist.  The  objective  findings  will  vary 
according  to  the  nature  of  the  abuse  that  has  taken 
place.  In  cases  induced  by  excessive  onanism  we  find, 
without  exception,  laxness  and  pallor  of  the  penis  and 
testicles,  a  smooth  scrotum,  and  low-hanging  testicles  in 
consequence  of  the  relaxation  of  the  muscular  fibers  in 
the  tunica  dartos.  The  orifice  of  the  urethra  is  red- 
dened, the  rest  of  the  urethra  pale  as  far  as  the  colliculus 
seminalis,  and  this  latter  is  in  different  degrees  of  inflam- 
mation. 

The  vaguest  signs  are  presented  by  those  cases  of  im- 
potence which  have  arisen  from  excesses  in  venery.  In 
forms  of  impotence  consequent  on  abstinence  the  result 
of  examination  is  only  apparently  negative,  since  the 
testicles  always  show  smaller  dimensions  than  is  natural, 
although  the  penis  may  not  show  any  change  in  its  form. 

The  objective  result  in  the  external  form  of  the  sexual 

1  Die  Endoscopie  der  Harnrohre  und  Blase,  Deutsche  Chirur- 
gie.  Stuttgart,  1881,  Lieferung  51,  p.  173. 


DIAGNOSIS.  213 

organs  is  always  of  relative  importance,  because  it  has 
first  to  be  compared  with  the  former  state  before  a  con- 
clusion can  be  arrived  at  about  the  abuse  that  has  taken 
place. 

Generally  negative  results  are  obtained  in  the  objective 
examinations  of  the  sexual  organs  in  those  forms  of 
sexual  neurasthenic  impotence  which  have  not  been 
caused  by  a  mismanagement  of  the  sexual  power,  but 
are  founded  entirely  on  a  neuropathic  predisposition ; 
for  instance,  relative  impotence  not  induced  by  weak- 
ness never  presents  any  pathological  changes.  In  the 
other  neurasthenic  forms, — as,  for  example,  so-called 
psychical  impotence, — we  discover  here  and  there  signs 
of  atony  of  the  sexual  apparatus,  and,  besides  this,  in 
so-called  irritable  weakness  we  discover  sometimes  dif- 
ferent grades  of  inflammation  of  the  colliculus  semi- 
nalis. 


CHAPTER   VII. 
PROGNOSIS. 

THERE  is  nothing  to  be  said  about  prognosis  in  gen- 
eral, since  every  individual  case  carefully  considered  has 
first  to  establish  fundamental  points  on  which  may  be 
grounded  a  prognosis  that  even  then  is  not  always 
reliable. 

The  prognosis  is  absolutely  unfavorable  in  cases  of 
absence  of  the  penis,  of  both  testicles,  of  excessive 
smallness  of  the  sexual  organs,  of  excessive  hypospadia 
or  epispadia.  It  is  more  or  less  favorable  in  the  other 
kinds  of  organic  impotence. 

In  the  forms  of  impotence  dependent  on  other  bodily 
defects  the  prognosis  is  based  entirely  on  the  physician's 
ability  to  remove  the  primary  disease. 

The  prognosis  in  the  forms  of  congenital  impotence 
is  always  doubtful,  because  we  seldom  succeed  in  the 
treatment  of  inherited  defects  or  abnormalities  of  I  ho 
sexual  instinct,  or  in  the  effort  to  lead  it  into  a  more 
natural  channel. 

In  the  forms  of  neurasthenic  impotence  following  bad 
management  of  the  sexual  power  the  prognosis  is  very 
varying,  depending  on  the  symptoms  in  each  individual 
case.  In  cases  accompanied  by  persistent  pollutions 
the  prognosis  is  always  doubtful,  because  we  can  never 
know  whether  the  pollutions  or  spermatorrhea  can  be 
mastered.  In  impotentia  ex  abstinentia  also  the  prog- 
214 


PROGNOSIS.  215 

nosis  is  doubtful  in  case  atrophy  of  the  testicles  has 
already  set  in.  The  prognosis  is  generally  favorable  in 
the  forms  of  so-called  psychical  impotence. 

My  personal  experience  proves  to  me  that  Eulenburg l 
is  not  absolutely  correct  when  he  makes  the  statement 
that  the  prognosis  is  better  in  cases  of  merely  functional 
injury,  in  hyperesthesia  of  the  prostata  and  pars  pros- 
tatica,  than  when  there  are  serious  and  palpable  struct- 
ural changes,  such  as  cystitis,  prostatitis,  strictures,  etc. 
I  would  declare  this  assertion  correct  only  in  reference 
to  grave  "  structural  changes,"  in  which  case  I  should, 
however,  not  include  cystitis  or  stricture,  nor  even 
simple  prostatitis.  For  my  part,  I  much  prefer  to  find* 
those  structural  changes  to  be  the  cause  of  the  impo- 
tence or  sexual  neurasthenia  than  to  discover  that  the 
neurasthenia  is  an  independent  disease.  In  purely 
neurasthenic  disorders  the  successful  treatment  is  not 
so  easily  accomplished  as  in  cases  of  curable  structural 
changes. 

The  prognosis  in  general  depends  on  the  result  of  the 
examination.  We  can  augur  it  to  be  favorable  in  case 
of  youth  or,  at  least,  early  manhood,  strong  constitution, 
otherwise  sound  general  health,  preserved  sensibility, 
electrical  irritability,  normal  temperature,  and  vascu- 
larity  in  the  sexual  organs.  The  absence  of  these  con- 
ditions makes  the  prognosis  correspondingly  doubtful,  or 
even  positively  unfavorable. 

The  physician  should,  however,  always  bear  in  mind 
that  there  are  few  persons  impotent  through  any  cause 
except  old  age  who  cannot  profit  by  a  rational  or  judi- 
cious treatment.  Consequently  he  must  engage  in  the 

1  Sexuale  Neuropathic.     Leipzig,  1895,  p.  33. 


216  SEXUAL  IMPOTENCE. 

treatment  of  impotence  with  just  as  much  zeal  and 
courage  as  he  would  display  in  the  treatment  of  any 
other  curable  disease  ;  and  he  may  feel  convinced  that 
by  the  cure  of  one  impotent  individual  he  will  dry  many 
tears  and  do  a  great  amount  of  good. 


CHAPTER    VIII. 

PROPHYLAXIS. 

"  Medicina  est  conservatio  sanitatis  et  curatio  segritudinis  " 

IT  must  be  granted  by  all  that  impotence  is  one  of  the 
modern  diseases.  A  physician  who  does  not  occupy 
himself  with  impotence  has  no  conception  of  its  great 
prevalence,  nor  does  he  understand  that  young  people 
may  be  impotent  without  any  one  suspecting  it.  Very 
few  have  the  courage  to  consult  a  doctor  about  these 
maladies  honteuses,  as  they  are  called  by  all  civilized 
nations. 

Only  an  insignificantly  small  proportion  of  those  who 
have  become  prematurely  impotent  owe  this  severe  in- 
firmity to  an  inherited  congenital  or  innocently  acquired 
deformity  or  disease.  The  majority  have  become  pre- 
maturely impotent  because  they  have  been  left  to  them- 
selves and  to  chance.  However  well  an  individual  may 
be  led  and  directed  in  general,  in  the  most  important 
concern  of  life,  the  sexual  life,  he  commonly  receives  no 
guidance.  If  one  is  possessed  of  spirit  or  energy  and 
common  intelligence,  he  may  now  and  then,  in  his 
sexual  experiences,  stumble  into  different  snares  ;  but  if 
no  serious  injury  is  sustained,  he  may  eventually  attain 
senile  impotence,  the  natural  goal  of  a  healthy  man. 
However,  an  unlucky  accident  or  the  following  of  a  mis- 
directed path  may  lead  to  a  disease  that  brings  a  speedy 
end  to  virility. 

So,  before  we  can  speak  of  a  general  prophylaxis  of 

217 


218  SEXUAL  IMPOTENCE, 

impotence,  we  should  first  feel  convinced  that  it  is  highly 
unwise  to  allow  any  young  man  to  enter  upon  the  path 
of  physical  love,  which  is  strewn  with  thorny  roses,  with- 
out furnishing  him  first  with  some  good  instruction.  It 
is  true,  most  men  acquire  a  certain  experience  in  time  ; 
but,  alas !  many  pay  for  it  very  dearly,  and  often  with 
the  loss  of  their  power. 

The  prophylaxis  of  impotence  is  closely  conned  <•<  I 
with  the  prophylaxis  of  onanism,  because  the  great  ma- 
jority of  all  those  who  have  become  prematurely  impo- 
tent commenced  with  onanism  at  an  early  age.  First 
of  all  is  required  a  strict  but  loving  and  rational  surveil- 
lance of  the  children.  Next  comes  instruction  as  soon 
as  the  first  signs  of  puberty  appear.  This  instruction, 
however,  should  be  given  without  heating  the  imagina- 
tion and  without  the  help  of  those  books  of  horror,  the 
so-called  popular  scientific  works  which  generally  con- 
tain some  piquant  stories. 

When  a  child  has  given  evidence  that  he  practises 
onanism,  every  possible  effort  should  be  made  in  order 
to  induce  him  to  desist  from  the  evil  habit.  The  details 
of  the  various  ways  of  discovering  onanists,  the  methods 
for  curing  the  evil  with  its  consequences,  etc.,  cannot  be 
treated  here  at  length.  All  this  may  be  found  in  spe- 
cial works,  and  we  wish  particularly  to  mention  that  of 
Fournier. 

In  the  treatment  of  onanism  the  individual  has  to  be 
carefully  studied :  not  every  child,  nor  youth,  nor  even 
man,  has  sufficient  will-power  to  combat  successfully 
this  evil  so  difficult  to  conquer.  In  many  cases  the  ob- 
ject will  be  attained  by  incessant  watching,  or  ultimately 
by  the  application  of  a  suitable  preventive  apparatus, 
which  the  child  must  wear  day  and  night. 


PROPHYLAXIS.  219 

Mature  individuals  should  be  advised  to  satisfy  the 
sexual  instinct  in  a  natural  way,  and  no  notice  must  be 
taken  of  the  cry  of  horror  uttered  by  pharisaical  medi- 
cal authorities  or  by  those  who,  although  possessed  of 
great  scholarship,  are  nevertheless  destitute  of  experi- 
ence. 

The  notion  that  whoever  has  once  enjoyed  natural 
copulation  will  not  feel  tempted  to  return  to  onanism  is 
an  error  that  is  somewhat  prevalent.  Only  copulation 
that  is  practised  regularly,  satisfying  every  strong  and 
real  desire,  can  cure  onanism  ;  while  copulation  enjoyed 
at  long  intervals  only  would  rather  incite  to  more  fre- 
quent onanism,  because  pleasing  recollections  are  near 
at  hand. 

We  know  that  absolute  continence  is  attended  by 
bad  consequences ;  it  gradually  extinguishes  the  sexual 
power,  and  does  so  the  sooner  and  the  more  easily  the 
weaker  the  original  virility.  It  is  really  ludicrous  for 
Bourgeois1  to  admit  that  he  prefers  nocturnal  pollutions 
to  coition,  and  to  ask  why  one  cannot  leave  the  sexual 
organs  inactive  and  enjoy  good  health.  He  points  to 
the  peasant,  who  does  not  exercise  his  mind,  and  the 
prisoner,  who  does  not  fatigue  his  apparatus  of  loco- 
motion.2 No  doubt  this  may  be  true,  but  then  we 
shall  see  the  abstinent  just  as  virile  as  the  peasant  is  in- 
tellectual and  as  the  prisoner  is  enjoying  his  exceptional 
health. 

We  have  already  stated  that  it  is  utterly  impossible 
to  fix  a  general  rule  as  to  how  often  coition  is  to  be  ac- 
complished. Personal  disposition  and  force,  phenomena 

1  Les  passions.     Paris,  1877,  p.  123. 

2  Bourgeois,  op.  cit.,  p.  119. 


220  SEXUAL  IMPOTENCE. 

preceding  and  succeeding  coitus,  are  proper  guides  to 
show  each  reasonable  individual  where  the  line  of  suf- 
ficiency is  drawn.  Every  effort  beyond  this  is  injurious. 
No  individual  should  take  another  as  an  example  for  his 
own  conduct,  because  constitution,  hereditary  condition, 
temperament,  age,  education,  manner  of  living,  occu- 
pation, state  of  health,  all  are  active  in  establishing  dif- 
ferences in  sexual  vigor,  either  for  the  time  only  or 
permanently,  and  it  would  be  perfectly  useless  to  com- 
bat these  influences.  Let  each  man  be  satisfied  with 
what  has  been  bestowed  upon  him. 

Timorous  patients,  and  healthy  persons  also,  who 
see  in  their  doctor  their  best  friend,  often  ask  what 
part  of  the  day  or  the  night  is  the  most  appropriate 
for  coition. 

My  answer  is  invariably,  that  moment  which  is  most 
convenient  and  when  the  sexual  desire  is  most  urgent. 
From  an  esthetic  point  of  view  the  evening  hours  are 
the  time  for  love.  Persons  with  weakened  virility  are 
accustomed  to  take  advantage  of  the  erection  in  the 
morning.  Some  medical  men  have  uttered  their  veto 
against  this  habit ;  but  this  veto  is  unreasonable,  since, 
when  the  erection  is  not  indicative  of  a  real  want,  the 
member  slacks  at  the  first  movements  and  coitus  can- 
not be  accomplished. 

The  physician  is  also  frequently  asked  in  what  position 
the  act  ought  to  be  carried  out.  Here  also  a  brief  answer 
is  all  that  is  due :  all  positions  except  the  upright  are 
equally  advisable  from  a  hygienic  standpoint.  If  the 
ecclesiastic  prescriptions  on  this  subject  are  disregarded, 
the  most  convenient  position  is  the  one  to  choose.  Co- 
itus a  parte  postica  is  decidedly  the  most  natural  and 
favorable  for  generation.  It  is  also  the  most  convenient 


PROPHYLAXIS.  221 

way  for  corpulent  persons.  This  is  the  mode  that  is 
said  to  be  followed  always  in  Australia,  because  the 
genitalia  of  the  women  there  are  placed  a  little  farther 
back.1  The  Jews  believed  that  coition  in  the  usual  way 
produced  children  who  were  generally  not  so  good,  wise, 
or  talented,  and  did  not  give  ground  for  so  much  hope, 
as  those  resulting  from  copulation  a  parte  postica. 
This  doctrine  was  an  abomination  in  the  eyes  of  Mo- 
hammed, and  therefore  he  stated,  according  to  the 
Hediths  (traditions),  that  the  following  verse  of  the 
Koran  had  descended  from  heaven :  "  The  woman  is 
your  field  ;  come  into  your  field  by  whatever  way  you 
choose."  (II.  Sure.,  p.  25,  verse  224.) 2 

In  intercourse  between  passionately  amorous  beings, 
one  of  whom  is  always  the  leader,  there  arise  some- 
times habits  of  certain  caresses  that  might  yield  sub- 
jects for  contention,  and  which  we  choose  to  designate 
simply  as  somewhat  piquant.  The  medical  adviser 
would  do  well  to  dissuade  from  caresses  that  are  rather 
too  piquant,  because  a  man  may  accustom  himself  to 
such  accessories,  and  then,  when  he  is  refused  them,  be 
impotent  for  the  time.  Sapienli  pauca. 

The  most  varying  opinions  prevail  in  regard  to  copu- 
lation during  the  menstrual  period.  If  we  compare  the 
menstrual  period  with  the  rutting  season  of  animals, 
some  question  is  aroused  as  to  the  advisability  of  hav- 
ing coition  with  a  menstruating  woman,  for  that  period 
would  seem  to  offer  the  most  favorable  opportunity  for 
procreation.  On  the  other  hand,  however,  it  should  be 


1  Ploss,  Das  Weib.     Leipzig,  1885,  p.  80. 

2  Der  Koran  iibersetzt  v.  Dr.  L.  Ullmann  ;  Nicolaus  v.  Tornauw, 
Das  moslemische  Recht.     Leipzig,  1855,  p.  73. 


222  SEXUAL   IMPOTENT  K. 

staled  that  most  nations  observe  a  custom,  a  religious 
rule,  or  a  law,  that  a  menstruating  woman  is  not  to  be 
touched.  It  is  further  to  be  observed  that  SOUK;  HMD 
\\ilh  sensitive  mucous  membranes  may  get  urethra! 
catarrh.  Again,  it  is  to  be  noted  that  many  women  are 
actually  sick  during  menstruation;  that  coitus  with  a 
menstruating  woman  shocks  the  sense  of  cleanliness ; 
and,  finally,  that  the  increase  of  the  population  has  not 
been  affected  among  nations  like  the  Jews  and  Mo- 
hammedans, where  the  woman  is  declared  unclean 
during  her  menstruation  and  coitus  is  strictly  prohibited. 
Thus  copulation  may  be  desisted  from  during  such 
period. 

In  recent  time  much  debate  has  been  carried  on 
about  the  hurtfulness  of  a  certain  process  during  copu- 
lation, which  the  French  have  termed  "  frauding."  In 
consideration  of  the  difficulty  one  meets  nowadays  in 
providing  for  a  large  number  of  children,  even  married 
people  often  feel  compelled  to  accomplish  coition  with 
certain  precautionary  measures  against  impregnation. 
For  this  purpose  are  used  condoms,  the  Paris  or  safely 
sponges,  pessaries,  and  other  similar  arrangements. 
Generally,  however,  the  penis  is  withdrawn  just  before 
ejaculation  takes  place.  Only  he  who  has  no  idea  of 
what  it  means  to  have  eight  children  and  little  or  no 
bread  will  contend  against  the  justification  for  these 
precautions.  The  use  of  a  well-made  and  sufficiently 
elastic  condom,  a  Paris  sponge,  an  occlusive  pessary,  or 
similar  arrangement  certainly  has  no  injurious  effect 
on  the  man,  and,  I  venture  to  assert,  no  harmful  effect 
on  the  woman.  The  theory  of  the  cooling  of  the 
uterus  by  the  ejaculated  semen,  advanced  by  Al.  Mayer 
and  Devay,  and  discussed  with  such  complacency  by 


PROPHYLAXIS.  223 

Bergeret,1  has  no  foundation  whatever.  It  is  easy  to 
convince  oneself  that  the  woman  during  ejaculation 
experiences  only  a  pleasant  sensation  of  warmth  and 
moisture,  and  by  the  use  of  the  above-mentioned  meas- 
ures of  precaution  the  continued  friction  of  the  penis 
against  the  clitoris  and  the  whole  surface  of  the  vaginal 
mucous  membrane  assists  the  woman  in  continuing  the 
venereal  orgasm  to  the  end. 

The  circumstances  are  far  more  favorable  for  the 
man  than  for  the  woman  when  the  penis  is  withdrawn 
the  moment  before  ejaculation.  For  him  the  eretliismus 
ends  with  the  act  of  ejaculation,  and  he  does  not  suffer 
in  any  way  if  a  smaller  quantity  of  sperm  is  emitted 
in  consequence  of  the  premature  ceasing  of  the  move- 
ments of  coition.  Matters  are  different  concerning  the 
woman  :  she  is  sometimes  in  the  midst  of  a  most  intense 
orgasmus  venereus  when  the  cessation  of  the  friction 
occurs  suddenly,  and  this  may  cause  disturbances  in  the 
nervous  as  well  as  in  the  sexual  system ;  for,  according 
to  the  present  state  of  our  experience,  it  must  be  as- 
sumed that  the  effect  of  an  abnormal  act  is  injurious, — 
i.e.,  if  the  act  has  not  been  continued  until  the  satis- 
faction of  the  sensation  produced  by  the  ejaculation  is 
experienced.  The  explanation  of  this  is  that  if  the  con- 
traction of  the  muscles  does  not  take  place,  the  genital 
tube  remains  surcharged  with  blood  ;  the  hyperemia  sub- 
sides but  slowly,  and  may  be  the  cause  of  changes  in  the 
tissue,  or  a  genital  derangement.2 


1  Des  fraudes  das  I'accomplissement  des  fonctions  generatrices. 
Paris,  1884 

2  Krafft-Ebing,  Ueber   pollutionsartige   Vorgange  beim   Weibe. 
Wiener  med.  Presse,  1888,  Nr.  11. 


224  SEXUAL  IMPOTENCE. 

The  statements  that  Bergeret  makes  in  this  respect 
are  probably  much  exaggerated.  I  am  in  a  position  to 
1 1 i.iki>  the  following  statements  resulting  from  personal 
experience.  Some  women  bear  perfectly  any  kind  of 
frauding,  even  the  last  mentioned,  whilst  others  very 
soon  become  nervous,  and  even  have  hystero-epileptic 
fits  or  suffer  from  catarrh  of  the  cervix  of  the  womb. 
In  contrast  with  earlier  experiences,  several  cases  have 
come  under  my  observation  in  more  recent  years,  in 
which  I  found  that  with  men  also  frauding  caused  some 
slight  neurasthenic  phenomena  and  an  injurious  effect 
upon  the  sexual  desire.  The  sudden  interruption  of 
coitus  is  not  easily  borne  by  passionate  men,  the  indi- 
vidual differences,  however,  being  great.  It  is  certainly 
possible  that  "  the  bad  habit  of  withdrawal  indulged  in 
with  the  object  of  preventing  conception  of  the  woman 
without  foregoing  the  pleasures  of  coitus"  may  be  one 
of  the  causes  of  prostatorrhea ;  but  I  cannot  agree  with 
Sturgis1  when  he  further  reasons  that  because  indul- 
gence in  coitus  interruptus  does  not  produce  the  same 
satisfaction  which  coitus  does,  "  there  is  a  constant  hank- 
ering for  more  intercourse.  This  inordinate  desire  gives 
rise  to  more  frequent  copulation,  until  hyperaestlicsiu 
is  set  up  in  the  prostatic  urethra,  which  is  thought  to 
be  relieved  by  more  coitus,  and  thus  a  vicious  circle  is 
established ;  the  more  the  patient  copulates  the  more 
the  irritation,  and  the  greater  the  irritation  the  more  the 
desire  for  coition." 

My  experience  in  nearly  all  the  cases  observed  was  a 


1  Sturgis,  Prostatorrhea  simplex  and  urethrorrhea  ex  libidine, 
Journal  of  Cutaneous  and  Genito-Urinary  Diseases.  New  York, 
June,  1898,  p.  270. 


PROPHYLAXIS.  225 

lowering  of  the  sexual  desire  in  men,  and  consequently 
it  cannot  be  the  u  over-indulgence  in  coitus  which  does 
most  of  the  mischief." 

Bergeret  seems  to  have  conceived  a  pet  idea  which  he 
works  out.  If  a  man  or  woman  given  to  such  habits 
is  seized  by  any  disease,  he  attributes  it  to  frauding, 
although  every  one  of  the  diseases  he  mentions  occurs 
without  any  discoverable  cause.  Bergeret  goes  so  far  as 
to  adduce  theological  reasons  against  frauding.  He  would 
deny  marriage,  and  therefore  copulation,  to  the  poor.  In 
spite  of  daily  experience  to  the  contrary,  he  asserts  that 
a  mother  of  eight  or  ten  children  looks  young  in  com- 
parison with  a  woman  who  has  for  a  few  years  only 
been  addicted  to  sexual  extravagances.  Bergeret,  con- 
sulted by  unmarried  women  of  different  ages  who,  in 
consequence  of  frauding,  are  declining  and  suffering 
from  profuse  menorrhagia,  is  able  to  cure  them  by  ad- 
vising marriage.  As  if  by  enchantment  they  all  become 
pregnant  and  well.  We  can  but  come  to  the  conclusion 
that  Bergeret  rides  a  hobby,  and  is  ready  to  attribute  to 
the  habit  of  frauding  any  disease  observed  in  a  person 
addicted  to  it,  without  taking  into  consideration  that  all 
these  diseases  are  to  be  found  without  any  apparent 
cause. 


15 


CHAPTER    IX. 
TREATMENT. 

IMPOTENCE,  always  difficult  to  cure,  is  often  incurable. 
The  great  number  of  methods  and  remedies  recom- 
mended speaks  for  the  small  value  of  most  of  them  ; 
and  yet  there  is  hardly  any  one  of  them  that  could 
be  entirely  dispensed  with,  because  there  are  cases  in 
which  the  one  or  the  other  may  be  of  some  use. 

The  treatment  of  impotence,  this  many-headed  hydra, 
varies  according  to  form,  phenomena,  and  state.  The 
treatment  of  one  form  of  impotence  varies  in  regard  to 
stage  and  accessory  phenomena,  and  the  remedies  have 
often  to  be  changed  before  one  can  obtain  a  cure.  One 
and  the  same  remedy  has  not  an  equal  effect  on  all  men  ; 
allowance  must  be  made  for,  or  due  attention  paid  to, 
idiosyncrasies  of  the  patients,  who  are  most  of  them 
neurasthenics. 

In  the  choice  of  any  therapeutic  measure  we  must 
take  into  account  everything, — the  state  of  the  sexual 
organs  and  general  bodily  conditions,  the  time  taken  by 
individual  metabolism,  age,  habits,  occupation,  and  man- 
ner of  living.  Often  the  system  accustoms  itself  to  a 
remedy  and  renders  quite  inoperative  one  that  had 
formerly  done  favorable  work. 

The  success  or  failure  of  a  treatment  depends  on  the 
choice  of  the  remedies,  and  in  order  to  be  able  to  choose 
the  proper  one  in  a  given  case  the  physician  must,  first 

226 


TREATMENT.  227 

of  all,  have  a  great  amount  of  experience  in  that  di- 
rection ;  he  must  make  his  examinations  with  great  care 
and  employ  much  ingenuity.  In  order  to  secure  a  pros- 
pect of  success,  he  must,  in  the  first  place,  gain  the  con- 
fidence of  his  patient.  The  sick,  as  a  rule,  approach 
the  medical  man  with  little  hope  and  confidence.  To 
this  is  added  false  shame,  which  makes  them  very  re- 
served. Most  physicians  care  little  for  such  patients,  and 
therefore  dismiss  them  after  a  superficial  examination. 
This  will  not  help  to  increase  the  hopefulness  and  confi- 
dence of  the  palient.  In  order  to  win  this  the  physician 
should  at  least  show  a  certain  degree  of  interest  and 
sympathy.  He  must  question  his  patient  very  closely 
and  examine  him  equally  carefully.  This  is  necessary 
for  the  diagnosis  alone. 

If  the  physician  inspires  the  patient  with  some  courage 
and  confidence,  he  has  by  that  means  taken  the  first 
step  in  the  treatment,  because  every  impotent  person 
must  first  of  all  be  treated  psychically.  As  soon  as  such 
a  patient  has  once  conceived  some  hope  for  his  curability 
and  confidence  in  the  physician  he  shows  himself  an 
exemplary  patient  and  will  subject  himself  to  any  treat- 
ment. Nothing  is  too  difficult,  nothing  too  disagreeable, 
nothing  too  painful.  Even  individuals  who  are  very 
much  reduced  in  strength  and  energy,  in  consequence 
of  onanism  or  pollutions,  are  no  exception  in  this.  I 
emphasize  this  expressly  in  contrast  to  Lallemand's  l 
statements,  which  may  have  been  correct,  because  in  his 
time  the  sick  had  more  cause  to  fear  medical  men  and 
their  methods  of  treatment. 

In  case  the  physician  should  discover  some  of  the 

1  Lallemand,  op.  cit.,  tome  iii.  pp.  129  and  131. 


228  SEXUAL  IMPOTENCE. 

causes  of  impotence  still  in  existence,  he  must  remove 
I hriu  as  speedily  as  possible.  Often  the  impotence  dis- 
appears with  its  causes ;  but  at  any  rate  there  can  be  m> 
question  of  any  treatment  for  impotence  before  the  causes 
are  removed. 

The  methods  for  treating  impotence  are  manifold,  as 
already  stated.  There  is  a  general  and  a  local  treat- 
ment ;  the  application  of  medicaments,  hydro-therapeu- 
tics, electricity,  and  massage.  Each  one  of  these  groups 
comprises  many  single  methods  and  remedies.  In  tin- 
treatment  of  a  disease  that  is  so  difficult  to  cure  we  must 
make  use  of  every  means  at  our  disposal,  each  remedy 
being  applied  at 'the  indicated  moment  and  opportunity. 
It  goes  without  saying  that  a  mere  excitation  of  the 
genitals  or  their  nerve-centers  which  would  be  but 
transitory  in  its  effect,  and  would  not  at  the  same  time 
have  the  tendency  to  strengthen  them,  can  never  be  the 
object  of  a  rational  and  conscientious  therapy. 

We  shall  now  discuss  every  curative  method,  and  con- 
clude with  the  discussion  of  the  therapy  for  every  state 
of  impotence. 

Psychical  treatment  is  indispensable  in  every  form 
of  impotence  excepting  the  organic.  Psychical  treat- 
ment forms  in  some  measure  the  introduction  and  be- 
ginning of  every  other  manner  of  treatment.  It  has 
been  stated  above  that  first  of  all  the  physician  must 
caiKjuer  the  hopelessness  and  distrust  of  his  patient.  This 
is  frequently  very  difficult  of  accomplishment,  particu- 
larly with  patients  who  have  already  engaged  in  the  study 
of  several  so-called  popular  scientific  works,  and  with 
the  greatest  difficulty  with  patients  who  happen  to  be 
medical  men.  I  have  had  many  an  opportunity  to  treat 
neurasthenic  physicians  for  impotence,  and  especially 


TREATMENT.  229 

since  the  appearance  of  the  first  German  edition  of  this 
work.  I  met,  without  exception,  with  nearly  insur- 
mountable difficulties. 

The  next  step  is  to  induce  the  patient  not  to  think 
continually  of  his  disease.  For  this  purpose  those  who 
are  impotent  or  believe  themselves  so  should  endeavor 
to  find  various  distractions.  They  should  be  recom- 
mended any  kind  of  pastime  which  involves  some  bodily 
exercise  ;  such,  for  instance,  as  some  suitable  occupa- 
tion that  is  not  fatiguing  and  is  at  the  same  time  attrac- 
tive,— driving,  riding,  theaters,  concerts,  balls,  gymnastics, 
fencing,  swimming,  skating,  bicycling,  rowing,  pleasant 
journeys  that  are  of  moderate  duration,  etc. 

The  patient  should  be  most  strictly  forbidden  any 
useless  sexual  excitement,  reading  of  lascivious  books, 
contemplating  piquant  pictures,  and  so-called  mental 
onanism.  Persons  who  have  experienced  a  repeated 
fiasco  with  women  are  in  the  habit,  before  they  proceed 
to  coition,  to  excite  themselves  sexually  in  sundry  ways 
in  order  to  prepare  themselves  for  the  act ;  but  they 
regularly  find  that  the  result  is  the  very  opposite  to  what 
they  had  in  view,  and  this  introductory  excitement  is 
often  the  cause  of  impotence. 

The  patient  must  be  told  not  to  allow  single  failures  to 
affect  him  too  gravely,  but  to  look  upon  them  with  more 
indifference,  and  treat  them  as  casual  mishaps.  It  is 
not  uncommon  that  virility  returns  with  the  peace  of 
mind,  while  erection  will  not  appear  when  it  is  most  ar- 
dently wished  for.  This  is  a  reason  for  the  well-known 
fact  that  young  husbands  who  fancy  they  are  impotent 
are  often  cured  by  the  mere  forbidding  of  coition.  The 
object  is  to  re-establish  mental  composure,  with  which 
often  comes  the  erection  also. 


230  SKXITAL  IMPOTENCE. 

A  physician  must  never  suppose  that  it  is  possible  to 
put  an  end  to  impotence  by  simply  denying  it,  even  Avere 
it  psychical  impotence.  If  the  physician  denies  facts 
that  have  been  experienced  by  the  patient,  he  simply 
loses  the  latter's  confidence  irrevocably.  Frequently 
medical  men  are  led  to  believe  they  have  to  deal  Avith  a* 
case  of  hypochondria,  Avhen  upon  investigation  they  find 
they  have  made  an  error  in  diagnosis.  Hypochondria  is 
a  very  rare  disease,  and  exists  Avithout  any  reason  or 
cause  Avhatever  only  in  persons  of  unsound  mind,  and 
even  then  such  mental  disturbance  is  itself  the  cause  of 
the  hypochondria. 

We  have  already  said  that  any  exixtin;/  cause  of  impo- 
tence must  first  be  removed  before  the  treatment  of  the 
impotence  itself  can  commence  ;  organic  obstacles  must, 
if  possible,  be  removed  by  surgical  operation  ;  diseases 
causing  impotence  should  be  treated  appropriately ;  onan- 
ists  must  be  cured  of  their  habit,  and  proper  remedies 
applied  in  case  there  is  spermatorrhea,  pathological  irri- 
tation, or  a  condition  of  Aveakness  in  the  genitalia. 

We  shall  devote  a  more  detailed  discussion  to  the 
treatment  of  spermatorrhea,  because  spermatorrhea  is 
frequently  the  sole  cause  of  impotence,  and  plays  an 
important  part  in  nearly  every  case.  The  treatment  of 
spermatorrhea  is  truly  in  a  lamentable  state.  The  first 
increase  in  the  frequency  of  pollutions  is  scarcely  ever 
treated  rationally,  because  the  patient  either  does  not 
mind  it,  or  avoids  consulting  a  physician  about  it  from 
false  modesty,  or,  finally,  because  he  finds  that  his  doctor 
neither  understands  his  ailment  nor  even  listens  to  his 
story.  Yet  one  needs  no  demonstration  in  order  to  see 
that  it  is  of  the  utmost  importance  that  spermatorrhea 
should  be  combated  from  its  very  beginning.  In  our 


TREATMENT.  231 

practice  we  often  discover  what  desperate  efforts  are 
made  by  the  patient  in  his  struggle  a"gainst  the  constantly 
increasing  frequency  of  the  pollutions ;  what  unreliable 
remedies  are  adopted,  and  how  the  body  is  chastised  ;  or 
how  every  enjoyment,  every  comfort,  is  denied  oneself, 
.everything  is  tried  that  has  been  mentioned  or  praised 
by  physicians,  friends,  and  books  as  being  of  good  effect 
in  the  case  in  question.  Many  a  remedy  or  measure 
seems  at  first  to  have  some  good  effect,  but  loses  all  effi- 
cacy after  a  time.  Meanwhile  the  precious  time  passes 
and  the  pollutions  grow  worse.  Lallemand1  tells  of 
some  examples  that  are  really  characteristic  and  are 
taken  from  life. 

The  treatment  of  spermatorrhea  is  a  very  delicate  and 
difficult  affair.  It  engages  in  its  service  nearly  all  the 
therapeutic  remedies  and  expedients  which  find  their 
application  in  the  treatment  of  impotence,  and  of  which 
we  shall  speak  later  on.  Thus  it  includes  in  some  special 
cases  the  use  of  medicaments,  hydro-therapy,  electro- 
therapy, and  local  endoscopic  treatment. 

As  a  matter  of  course,  we  must  in  the  first  place 
search  for  the  etiological  factor,  so  that  it  may  be  re- 
moved as  soon  as  possible.  Onanisnj,  which  is  the  most 
frequent  cause  of  spermatorrhea,  must  be  considered  at 
once.  Besides  this,  a  phimosis,  if  such  exists,  must  be 
corrected  by  surgical  operation,  even  if  it  is  not  of  a 
high  degree.  Phimosis  is  oftener  the  cause  of  persistent 
pollutions  than  one  would  think,  because  by  pressure  it 
irritates  the  member,  even  when  slightly  erected;  and, 
besides,  the  phimosis,  by  protection,  renders  the  glans 
more  irritable  or  sensitive  than  is  to  be  desired. 

1  Pertes  seminales,  tome  i.  pp.  294-304. 


232  SKXITAL   IMPOTENCE. 

Regulation  of  the  manner  of  living  will  present  spe- 
cial difficulties.  An  individual  suffering  from  pollutions 
must  in  the  evening  abstain  from  food  that  is  difficult  to 
digest ;  he  must  not  eat  any  spicy  dishes,  and  in  general 
special  attention  and  watchfulness  must  be  directed  to 
the  food  and  the  increase  of  the  activity  of  the  digestive 
organs.  The  patient  must  take  his  supper  at  least  three 
hours  before  sleep,  and  he  must  before  he  goes  to  bed 
empty  his  bladder,  and  at  all  times  care  for  regular  defe- 
cation. He  must  sleep  on  a  couch  or  bed  that  is  mod- 
erately hard,  but  not  too  hard, — best  on  a  horse-hair 
mattress.  My  observations  have  taught  me  that  persons 
suffering  from  persistent  pollutions  will  be  benefited  by 
sleeping  with  the  head  in  a  very  low  position,  so  that  the 
brain  can  be  better  fed  by  blood. 

Again,  the  patient  must  not  sleep  longer  than  the  neces- 
sary time,  which  should  be  determined  for  him.  In  bed 
he  must  not  be  covered  too  warmly,  and  he  must  not 
sleep  on  his  back.  His  trousers  must  not  be  too  tight. 
He  must  never  sit  on  upholstered  seats  ;  he  must  not 
ride  on  horseback ;  he  must  go  as  little  as  possible  in  a 
conveyance;  and  he  must  not  excite  himself  sexually 
\\ilhout  necessity.  Of  special  importance  is  the  regu- 
lating of  sexual  intercourse,  because  the  pollutions  can- 
not possibly  be  cured  during  absolute  abstinence. 

In  the  treatment  proper  the  physician  has  to  pay 
strict  attention  to  the  individual  case.  Hydro-therapeu- 
tic measures  combined  with  a  well-regulated  manner  of 
living,  and  eventually  a  trip  to  or  a  sojourn  at  a  water- 
ing-place, will  constitute  a  curative  method  that  most 
frequently  leads  to  a  satisfactory  result.  Balneotherapy l 

1  Kisch,  Grundriss  der  klinischen  Balneotherapie.  Wien  und 
Leipzig,  1883,  p.  292. 


TREATMENT.  233 

gives  the  best  result  in  those  cases  of  pollutions  and 
spermatorrhea  in  which  onanism  and  weakness  of 
the  nervous  system  are  the  causal  factors.  The  use 
of  pure  chalybeate  waters  and  ferruginous  waters 
charged  with  carbonic  acid  is  indicated  in  such 
cases. 

If  the  pollutions  have  originated  from  a  state  of  hyper- 
emia  in  the  pelvic  organs  caused  by  some  abdominal 
stasis  or  habitual  constipation,  good  effect  will  be  ob- 
tained by  taking  waters  containing  sodium  sulphate,  so- 
dium chlorid,  then  the  different  bitter  waters  and  some 
sulphur  waters.  We  might  add  here  that  in  a  state 
of  irritation  in  the  sexual  organs — i.e.,  in  cases  where 
chronic  inflammation  of  the  mucous  membrane  of  the 
bladder  or  of  the  urethra  is  the  cause  of  pollutions — the 
alkaline  waters  are  to  be  recommended,  and  will  do 
excellent  service.  When  the  mineral  waters  are  taken 
internally  we  should  observe  certain  precautions ;  for 
example,  only  small  doses  must  be  ordered,  so  as  not 
to  surcharge  the  bladder,  whereby  an  irritation  would 
be  induced.  The  waters  must  not  be  taken  in  the 
evening. 

When  an  increased  morbid  sensibility  of  the  nerves  is 
the  cause  of  the  pollutions  we  recommend  the  acrato- 
thermae  of  an  elevated  region ;  and  the  iron  mud-baths 
are  advisable  for  cases  in  which  simple  anemia  is  the 
cause  of  the  disease. 

Various  cold  water  treatments  and  sea-bathing  are 
indicated  in  most  conditions  of  weakness  causing  sper- 
matorrhea, but  these  remedies  should  be  selected  cau- 
tiously, individual  characteristics  being  taken  into  careful 
consideration. 

Rational  gymnastics  will  always  be  of  great  value  in 


234  SEXUAL  IMPOTENT!',. 

subduing  frequent  pollutions.  Schreiber1  recommends 
lor  this  purpose  different  exercises  for  chamber  gymnas- 
tics which  are  very  easy  of  execution,  do  not  require 
any  apparatus,  and  are  of  very  good  service,  particularly 
so  when  supported  by  some  other  means  of  treatment. 

An  electrical  treatment  is  only  rarely  indicated.  In 
the  endoscopic  examination  some  local  treatment  will 
often  appear  to  be  required  or  necessary,  mostly  the  use 
of  the  sound  or  bougie  and  Lallemand's  method  of 
cauterizing ;  but  always  by  the  guidance  of  the  endo- 
scope,  of  course.  These  measures  lead  most  frequently 
to  the  desired  result. 

Bromids  taken  internally  are  sometimes  of  excellent 
effect  in  cases  accompanied  by  erotic  excitement,  yet  they 
are  not  infallible.  Prescribing  them  is  an  easy  matter, 
and  the  sight  of  a  prescription  is  always  some  satisfac- 
tion for  both  doctor  and  patient ;  only  this  satisfaction  is 
not  always  of  long  duration  with  the  patient.  Camphor 
also  may  be  used  in  some  cases,  but  oftener  in  the  shape 
of  a  suppository  than  otherwise.  A  trial  with  secale 
cornutum,  with  tinctura  veratri  viridis,  monobromated 
camphor,  antipyrin,  sodium  nitrate,  and  eventually  with 
solutio  Fowleri,  may  also  be  advisable. 

According  to  Roscnthal,2  atropin  has  a  good  effect, 
but  only  in  cases  of  prostatorrhea.  I  have  a  prejudice 
against  atropin,  and  thus  have  never  ventured  to  make 
any  use  of  it,  although  in  certain  cases  I  have  felt 
tempted  to  make  an  experiment  with  it  in  consequence 
of  Loewenfeld's3  recommendation. 


1  Aerztliche  Zimmergymnastik.     Leipzig,  1883,  p.  95. 

1  Ueber  den  Einfluss  von  Nervenkrankheiten  auf  Zeugung  und 
Sterilitut.  Wiener  Klinik,  1880,  Heft  5,  p.  160. 

s  Die  nervosen  Stdrungen  sexuellen  Ursprunges.  Wiesbaden, 
1891,  p.  158. 


TREATMENT.  235 

M.  Meisels,  under  the  direction  of  Professor  A.  Bokai, 
made  some  experiments  with  cornutinum  cilricum,  and 
he  asserts  that  doses  of  0.003  to  0.006  (gram)  per 
day  acted  very  favorably  in  paralytic  spermatorrhea. 
In  most  of  the  cases  the  sperm  effusion  diminished  on 
the  second  or  third  day,  or  it  ceased  altogether.  In  from 
one  to  two  weeks  a  cure  generally  resulted.  This 
medicament  had  no  disagreeable  effects  even  after  nine 
months1  continuous  use.  In  spastic  forms,  however, 
cornutinum  citricum  is  considered  to  have  no  effect.  I 
have  tried  this  remedy  in  one  case  only,  with  apparently 
good  effect.  The  price  is  excessive. 

Professor  Bozzolo  and  Mangianti  recommend  the  fol- 
lowing prescription  for  spermatorrhea  and  anaphrodisia 
of  neurasthenics:  R.  Cornutin.  citr.,  0.03;  cretre  prae- 
par.,  3.0 ;  gummi  tragac.,  6.0.  M.  f.  pil.  No.  xx.  S.  2-4 
pills  daily. 

Of  course,  diseases  which  induce  pollutions  must  be 
treated  and  removed  in  any  case  whether  pollutions  ap- 
pear or  not.  Such  are  ascarides,  itching  and  smarting 
cutaneous  eruptions  about  the  genitalia  and  vicinity,  also 
hemorrhoids  and  fissures,  strictures  and  phimosis. 

The  various  mechanical  devices  invented  for  prevent- 
ing pollutions  cannot  be  of  much  use,  since,  though,  if 
well  constructed,  they  may  prevent  now  and  then  a 
nightly  effusion,  they  do  not  thereby  contribute  much 
toward  the  complete  removal  or  cure  of  the  disease, 
except  in  certain  cases  of  neurasthenic  conditions  and 
states  of  habit.  The  arrangements  that  prevent  the  pa- 
tient from  lying  on  his  back  deserve  more  consideration. 

In  special  cases  I  have  followed  Lallemand's l  exam- 

1  Lallemand,  op.  cit.,  tome  ii.  pp.  46-56. 


236  SEXUAL  IMPOTENCE. 

pie  and  ordered  continuous  application  of  cold,  whereby 
some  rather  satisfactory  results  were  obtained.  I  used 
in  these  cases  Chapman's  tubes  or  pipes,  which  facilitate 
the  application,  which  is  not  very  convenient  under  any 
circumstances. 

Kisch1  states  that  partial  bathing  is  recommended 
against  pollutions  in  youthful  individuals.  For  the  bath- 
ing of  the  occiput,  the  patient  is  in  a  horizontal  position 
and  has  the  back  of  his  head  in  a  specially  shaped  basin 
filled  with  cold  water.  Stimulating  applications  for  the 
upper  arms,  by  means  of  some  towel-like  material  soaked 
in  cold  water,  and  with  a  dry  cover,  are  likewise  of  good 
effect  now  and  then.  Finally,  I  wish  to  mention  for 
occasional  application  Winternitz's  psychrophor,  cold 
clysters,  and  Atzperg's  cooling  probe  for  the  rectum. 

Sometimes  the  cure  may  be  assisted  by  the  patient's 
will  and  firm  determination  to  awaken  at  the  proper 
time.2  For  the  cases  where  the  pollutions  take  place  in 
the  mornings,  we  have  L.  Casper's3  advice  to  awaken 
the  patient  regularly  by  some  arrangement  an  hour  before 
the  phenomenon  usually  occurs,  so  that  he  may  urinate. 
This  is  certainly  good  advice,  because  in  this  way  you 
may  break  the  force  of  habit.  The  patient  must  not 
then  be  allowed  to  fall  asleep  again. 

I  shall  now  return  to  the  discussion  of  the  different 
modes  of  treating  impotence  itself.  In  sexual  weakness 
or  anaphrodisia  special  weight  is  to  be  laid  on  a  hygienic 
manner  of  living.  Food,  physical  exercise,  and  rest, 

1  Op.  cit.,  p.  293. 

2  Campbell  Black,  On  the  Functional  Diseases  of  the  Urinary  and 
Reproductive  Organs.     London,  1875,  p.  172. 

s  Dr.  Leopold  Casper,  Impotentia  et  Sterilitas  virilis.  Miinchen, 
1890,  p.  102. 


TREATMENT.  237 

also  dwelling  and  clothing,  must  be  strictly  directed  ac- 
cording to  the  rules  of  hygiene. 

The  food  must  be  nourishing  without  being  stimu- 
lating. Roubaud  has  with  great  industry  compiled  a 
long  list  of  so-called  aphrodisiac  articles  of  food,  etc., 
which  may  be  of  some  benefit  in  special  cases  of  frigid- 
ity and  psychical  impotence,  or  for  the  days  preceding 
an  intended  copulation.  These  articles  are  in  some 
measure  of  mild  effect,  sometimes  of  no  effect,  but  cer- 
tainly are  harmless  stimulants.  Here  is  the  list:  Salt, 
zedoary,  saffron,  mustard,  cinnamon,  sage,  rape-plants, 
as  carrots,  turnips,  etc.,  marjoram,  nutmeg,  cardamo- 
murn,  mustard-plant,  arrowroot,  laurel,  leek,  ginger, 
garlic,  onions,  cloves,  peppers,  skirret  or  sugar-root, 
cryngo,  angelica,  parsnips,  celery,  fennel,  vanilla,  pork, 
game,  oysters,  fish,  etc. 

In  general,  the  nourishment  must  be  suited  to  the 
state  or  condition  of  the  body,  every  superfluous  pro- 
duction of  fat  being  injurious  to  virility.  On  the  other 
hand,  it  is  to  be  noticed  also  that  individuals  who  are 
possessed  of  considerable  sexual  power  enjoy  a  good 
appetite  and  digestive  power,  although  they  are  not 
gourmands,  or  do  not  become  such  until  their  riper 
years.  Persons  with  low  sexual  capacity  are  either 
gluttons  or  possessed  of  small  digestive  power. 

The  diet  is  of  special  importance  in  the  treatment  of 
all  chronic  diseases.  It  certainly  influences  in  a  certain 
degree  the  virile  power,  and  every  physician  will  there- 
fore do  well  to  inquire  about  the  nourishing  material  of 
every  impotent  patient,  and  correct  any  existing  error. 
Our  purpose  does  not  admit  of  the  use  of  the  diet  for 
producing  corpulency,  as  indicated  by  Mitchell,  Playfair, 
and  others.  I  am  ready,  however,  to  admit  that  con- 


238  SEXUAL  IMPOTENCE. 

sidcrablc  good  may  be  accomplished  when  such  treat- 
ment is  modified  in  the  manner  that  Furb ringer1  pro- 
poses,— i.e.,  that  the  patients  do  not  have  to  stay  in  bed. 
are  allowed  open  air  exercise  and  light  mental  work ; 
but  then  we  do  not  follow  Mitchell  and  Playfair.  Fiir- 
bringer  is  approaching  my  point  of  view,  although  he 
does  not  seem  to  notice  it.2 

Experience,  which  was  gathered  principally  in  North 
America,  leads  me  to  establish  and  to  follow  these  main 
rules.  The  impotent  must  abstain  from  spirituous  bev- 
erages. I  make  an  exception  only  in  the  case  of  per- 
sons of  feebly  developed  sexual  desire ;  these  may  take 
two  glasses  of  German  beer  or  one  glass  of  good,  strong 
California  wine  shortly  before  intercourse.  I  have  al- 
ready mentioned  the  favorable  effect  of  beer  in  cases 
of  precipitate  ejaculation.  Beer  or  wine,  however,  must 
never  be  taken  in  such  quantities  that  the  stimulating 
effect  may  be  followed  by  a  paralyzing  influence,  be  it 
ever  so  slight. 

The  manner  of  living  must  be  strictly  ordained  in  ac- 
cordance with  hygienic  laws,  and  a  proper  proportion  ob- 
served between  physical  or  mental  occupation  and  rest, 
which,  however,  is  of  equal  necessity  for  the  healthy 
and  for  the  sexually  weak.  The  patient  ought  to  divert 
himself  with  mental  exercise  and  amusements  of  every 
kind.  Gymnastics,  walks,  and  so  forth  should  be  resorted 
to  in  order  to  strengthen  the  body.  Fatigue  of  every 
kind  must  be  avoided,  and  every  effort  must  be  followed 
by  an  appropriate  interval  of  rest. 

1  Die  Storungen  der  Geschlechtsfunctionen  des  Mamies.    Wien, 
1895,  p.  66. 

2  Ibidem,  p.  136. 


TREATMENT.  239 

The  principal  rest  is  taken  during  sleep,  and  this  must 
be  apportioned  to  every  individual  according  to  his  re- 
quirement. The  patient  in  this  respect  is  often  in  an 
unfavorable  situation :  if  he  sleeps  sufficiently  long  to 
give  his  body  the  necessary  repose,  pollutions  take  place 
during  the  latter  part  of  this  time ;  and  if  he  denies  him- 
self part  of  this  repose,  then  faintness  and  exhaustion 
appear  and  exert  an  unfavorable  influence  on  the  pro- 
gress of  the  cure.  We  cannot  fix  upon  the  number  of 
hours  necessary  for  sleep  in  every  case ;  but,  on  an 
average,  eight  hours  should  suffice.  Of  course,  we  must 
pay  due  attention  to  the  condition  of  dwelling  and 
clothing. 

Although  medicaments  are  not  the  means  that  in  the 
treatment  of  impotence  lead  with  great  frequency  and 
safety  to  a  fortunate  issue,  yet  they  are  what  every 
sufferer  desires  and  often  asks  for,  after  having  given 
only  superficial  statements  about  his  complaint.  The 
question,  "  Will  you  prescribe  something  for  me  ?"  is 
never  missed.  The  prescription  may  sometimes,  in 
connection  with  other  remedies,  have  a  good  effect. 
Thus  I  shall  now  proceed  to  the  discussion  of  the  most 
common  medicaments. 

Philters,  or  love-potions,  have  been  known  as  far  back 
as  the  times  of  Moses.  The  mandrake  that  Rachel  is 
reported  to  have'  eaten  to  become  prolific  is  now  sup- 
posed to  be  atropa  mandragora,  and  belongs  to  the  genus 
belladonna.  Philters  are  brewed  and  drunk  in  our  days, 
with  and  without  effect. 

Cantharides  and  its  preparations  were  in  former  times 
the  commonest  remedies  used  for  impotence.  If  taken  in- 
ternally, the  most  effective  substance  of  the  cantharides, 
the  cantharidin,  is  excreted  by  way  of  the  urinary  pas- 


240  SEXUAL  IMPOTENCE. 

sages.  On  these  passages  cantharidin  lias  a  very  irri- 
tating influence,  and  in  proportion  to  the  size  of  the 
dose  it  may  lead  to  serious  hyperemia  of  the  mucous 
membranes  of  the  urinary  passages,  to  album  inuria, 
hematuria,  and  cystitis,  and,  in  the  worst  cases,  to  croupy 
deposits  on  the  mucous  membrane  of  the  bladder.  As 
secondary  symptoms  we  may  have  dysuria,  stranguria, 
and  painful  erections.  These  erections  are  certainly  to 
be  called  pathological,  and  yet  they  are  to  do  service  in 
coition.  Doses  of  cantharides  so  small  that  they  do  not 
cause  any  perceptible  inflammation  of  the  urinary  pas- 
sages do  not  cause  erection,  and  doses  so  large  as  to 
cause  energetic  erections  are  creative  of  such  dangers 
that  only  the  despair  of  a  patient  or  the  ignorance  of  a 
physician  can  give  rise  to  a  thought  of  applying  them. 
The  patient,  sufficiently  ignorant  and  sometimes  in  such 
a  state  of  mind  as  to  be  willing  to  sacrifice  his  life  for  one 
night  of  pleasure,  is  excusable,  but  there  is  no  excuse 
for  a  medical  man  who  would  use  cantharides.  It  is  to 
be  hoped,  however,  that  such  cases  do  not  occur  nowa- 
days. This  remedy  must  never  be  brought  into  requi- 
sition in  the  treatment  of  impotence,  nor  the  oil-beetles 
(May-worms),  meloes  majales,  which  are  related  to  the 
canlharides  by  the  acid  of  cantharidin  which  they  con- 
tain, or  the  oil  or  tincture  of  ants,  used  in  South  America.1 
Phosphorus  was  known  to  the  ancients  as  a  remedy 
for  sexual  weakness.  It  has  a  stimulating  influence  on 
the  nervous  system.  In  regard  to  this  remedy  we  have 
the  observations  by  Alphonse  Leroy  and  Bouttotz,2  and 
those  of  Delpech,  which  show  phosphorus  to  be  a  pow- 

1  Rosenthal,  op.  cit.    Wiener  Klinik,  1880,  Heft  5,  p.  163. 
1  Roubaud,  Traite  de  1'Impuissance.     Paris,  1876,  p.  133. 


TREATMENT.  241 

erful  stimulant.  I  have  always  had  occasion  to  use  phos- 
phorus for  impotence,  and  I  feel  justified  in  saying  that 
in  most  cases  it  has  given  satisfaction.  I  noticed  partic- 
ularly the  favorable  effect  it  had  on  the  mood  of  the 
patients,  and  I  feel  convinced  that  it  is  of  decidedly  good 
effect  in  cases  where  the  patient  has  become  indifferent 
or  melancholy.  There  is  no  bad  effect  noticeable  in  the 
cautious  administration  of  phosphorus,  even  from  con- 
tinued use  (in  pills  or  capsules  of  0.001  gram  three  or 
four  times  daily,  or  of  phosphoric  acid  twenty  to  thirty 
drops  in  a  glass  of  sweetened  water  several  times  a 
clay). 

Xn.v  -vomica  and  its  preparations  are  of  very  great 
value  in  all  forms  of  impotence,  although  the  effect  is  not 
very  vigorous,  and,  I  am  sorry  to  say,  is  of  but  short 
duration. 

The  extract  and  the  tinctura  nucis  vomicae,  also  strych- 
nin, are  justly  considered  as  tonics  and  remedies  that  ex- 
cite the  appetite  and  preserve  their  character  as  good 
nervines  in  many  neurasthenic  diseases.  Hence  it  will 
be  worth  while  to  give  them  a  trial ;  it  will  be  accom- 
panied with  some  advantage.  I  saw  the  best  results 
with  .patients  who  were  otherwise  healthy,  but  felt  a 
diminution  in  their  sexual  power  without  any  assign- 
able cause.  It  is  true,  the  effect  of  nux  vomica  is  not 
lasting,  but  after  it  has  been  used  the  sexual  power  will 
never  sink  below  the  level  that  existed  before  the  use. 
The  doses  recommended  are  from  five  to  twenty-five 
drops  of  the  tincture,  or  0.01  (gram)  of  the  extract,  three 
times  a  day. 

I  have  never  made  use  of  brudn,  because  it  is  so  very 
unreliable  and  of  such  different  effect  on  different  indi- 
viduals. 

16 


242  SEXUAL  IMPOTENCE. 

Secale  corn nf inn  and  its  preparations  are  also  recom- 
mended for  impotence,  or  rather  as  aphrodisiacs;  but, 
as  their  effect  is  of  but  short  duration,  and,  moreover, 
is  quite  unreliable,  we  can  dispense  with  them  in  all 
cases  unaccompanied  by  sperm atorrhca. 

Ergotin  is  recommended  by  Maximilian  v.  Zcissl l  to 
be  used  in  combination  with  quinin.  I  think  that  Hie 
quinin  as  a  roborant  in  this  combination  is  the  more 
powerful  ingredient  in  the  prescription. 

Quinin,  either  alone  or  in  combination  with  easily  as- 
similable preparations  of  iron,  will  effect  in  anemic  and 
weakly  impotent  persons  all  it  is  capable  of  effecting  in 
anemia  and  weakness.  If,  therefore,  a  physician  sees 
some  reason  for  assuming  that  a  patient  requires  a  robo- 
rant, then  he  will  with  some  ground  appeal  to  quinin  or 
iron  ;  but  he  need  not  expect  therefrom 'a  specific  effect 
on  the  sexual  functions. 

Equally  uncertain  are  the  volatile  stimulants,  as  musk 
and  castoreum.  They  may  induce  libido  but  no  erec- 
tions, and  are  consequently  dispensable. 

In  the  Orient  especially  some  narcotics  enjoy  the  re- 
nown of  being  aphrodisiacs.  Indian-hemp,  opium,  and 
morphin  given  in  certain  doses  produce  undoubtedly 
sexual  excitement  followed  by  powerful  erections.  It  is 
a  known  fact  that  hashish-eaters  and  opium-smokers 
experience  heightened  sexual  impulse  in  the  beginning 
of  these  fatal  habits.  The  "just,  subtle,  and  mighty 
opium"  is  capable  of  rousing  the  sexual  desire  to  a  very 
high  degree,2  and  this  is,  no  doubt,  due  to  increased 


1  Ueber  die  Impotenz  des  Mannes  und  ihre  Behandlung.     Wien. 
med.  Blatt.,  1885,  Nr.  16. 

2  Paul  Bonnestain,  L'Opium.     Paris,  1887,  p.  493. 


TREATMENT.  243 

reflex  irritability  of  the  spinal  cord.  These  means  are, 
nevertheless,  quite  unsuited  to  our  purpose,  on  account 
of  their  transitory  effect  as  well  as  the  subsequent  re- 
laxation, and  also  on  account  of  the  danger  that  their 
use  may  lead  to  a  habit,  the  fatal  consequences  of  which 
are  well  known.  At  best  the  trial  might  be  made  to  raise 
the  confidence  of  a  patient  suffering  from  neurasthenic 
impotence  ;  but  this  would  be  done  at  the  risk  of  a  per- 
fect failure,  since  the  effect  of  the  opiates  is  so  much 
dependent  upon  the  individual. 

Valerian  has  unjustly  the  name  of  an  aphrodisiac, 
because  it  only  lowers  the  reflex  irritability  of  the  spinal 
cord,  and  for  that  reason  it  is  recommended  as  a  seda- 
tive by  Arndt.1 

The  mildly  working  stimulants,  as  vanilla,  cinnamon, 
galanga,  and  several  spices,  are  of  very  transitory  and 
unreliable  action,  and  operate  only  in  persons  who  are 
easily  excited  sexually. 

Cocain  taken  internally  invariably  produced  sexual 
excitement  in  a  man  fifty-six  years  old.  I  had  pre- 
viously noticed  a  diuretic  effect  of  cocain,  but  I  am 
unable  to  decide  whether  there  is  any  causal  connection. 
Cheerfulness  is  always  the  effect  of  an  internal  use  of 
cocain.  This  is  diametrically  opposed  to  the  observa- 
tions of  Dr.  H.  Wells,  of  the  United  States  Navy,  who 
asserts  that  he  has  noticed  in  cocain  an  anaphrodisiac 
effect.  Further  experiments  and  investigations  would 
certainly  be  interesting. 

Finally,  we  mention  the  scincus  marinus.  This  little 
animal,  anything  but  pleasing,  has  for  a  long  time  been 
praised  as  a  popular  remedy,  and  in  some  countries  is 

1  Neurasthenie,     Wien  und  Leipzig,  1885,  p.  246 


244  SEXUAL  IMPOTENCE. 

even  now  named  as  ;i  domestic  remedy,  and  yet  it  con- 
liiins  no  substance  whatever  that  can  act  as  an  aphro- 
disiac. At  best  its  fat  midd.  possibly  induce  salacity. 

Daiiiitnm  (Turnera  aphrodisiaca),  its  liquid  extracts, 
and  other  quite  elegant  American  preparations  are  not 
what  they  are  represented  to  be  by  the  extraordinary 
advertisements. 

For  the  sake  of  completeness,  and  also  as  a  curiosity.  I 
must  state  that  homeopathy  also  has  taken  an  interest  in 
sexual  weakness,  and  endeavors  to  treat  it  by  adminis- 
tering the  salts  of  copper,  gold,  iron,  lead,  etc.1 

The  various  hydro-therapeutic  processes  have  always 
enjoyed  a  special  fame,  and  are  highly  recommended  by 
men  in  and  out  of  the  medical  profession  for  the  states 
of  sexual  weakness.  The  reputation  of  hydrotherapy 
in  general  increases  every  day,  and  with  it  also  that  of 
its  special  application  in  the  treatment  of  impotence. 
Kvery  one  who  feels  a  beginning  of  impotence  resorts, 
with  or  without  medical  advice,  to  cold  water  ablutions 
and  sitz-balhs.  These  remedies  are  of  feeble  action  and 
produce  but  little  effect. 

In  order  to  understand  the  action  of  water  on  parts  of 
the  human  body  which  are  in  a  pathological  condition, 
we  have  to  call  to  mind  the  principles  of  hydrotherapy. 
The  stimulating  effect  of  water  upon  the  body  is  always 
twofold, — thermal  and  mechanical,  the  one  or  the  other 
prevailing  according  to  the  manner  of  application. 

The  impress  of  the  thermal  stimulus2  upon  the  periph- 
eral terminations  of  sensitive  cutaneous  nerves  is  trans- 


1  Dr.  Christof  Hartung  von  Hartungen,  Ueber  virile 

mid  ileren  Heilbsirkeit  auf  inductivein  Wege.     Wien,  1884. 

'2  Winternitz,  Hydrotherapie.     Wien,  1877,  Band  i.  p.  49. 


TREATMENT.  245 

mitted  to  the  central  organs,  appreciated  by  these  as  sen- 
sations of  warmth  or  cold,  and  transmitted  by  them  by 
reflex  action  to  the  motor  system.  It  is  probable  that 
thermal  effects  have  also  a  local  action  through  the  in- 
fluence of  peripheral  ganglia  or  the  excitable  tissue  itself, 
and  without  the  mediation  of  the  central  nervous  sys- 
tem. Again,1  the  application  of  a  lower  temperature  over 
large  vascular  trunks  causes  the  latter  to  contract.  This 
narrowing  of  the  main  vessels  induces  diminution  in 
the  afflux  of  blood  toward  the  peripheral  ramifications 
of  the  trunk-vessels  that  are  contracted,  whereby  is  also 
induced  a  lowering  of  the  temperature  in  the  parts  of 
the  body  supplied  by  these  blood-vessels.  Again,  ex- 
periments2 have  proven  that  by  the  local  application  of 
water  of  different  temperatures  we  can  alter  at  will  the 
local  warmth  of  a  part  of  the  body  even  to  the  deeper 
tissues.  Finally,  stimulation  by  cold  increases  consider- 
ably the  tension  and  tonicity  of  the  smooth  and  striated 
muscle  acted  upon  as  directly  as  possible.3 

The  action  of  the  various  procedures  in  hydro-thera- 
peutics is  therefore  directed  first  on  the  nerves,  by 
means  of  these  on  the  vessels,  and  ultimately  on  smooth 
muscles.  The  water  must  therefore  be  applied  in  accord- 
ance with  the  various  requirements  of  the  cases  under 
treatment. 

There  is  no  case  of  impotence  where  one  or  the  other 
hydro-therapeutic  process  would  not  considerably  as- 
sist any  course  of  treatment ;  and  in  many  a  case  no 
other  remedy  is  required  to  effect  a  cure.  Again,  it 

1  Winternitz,  op.  cit.,  Band  i.  p.  75. 
*  Ibidem,  p.  36. 
3  Ibidem,  p.  119. 


246  SEXUAL  IMPOTENCE. 

must  be  remarked  that  an  untimely  application  of  a 
liylropathic  stimulus  may  also  do  harm. 

Out  of  the  immense  treasury  of  hydro-therapeutic 
procedures  we  can  appropriate  for  our  purposes  local 
and  general  ablutions,  rubbing  down,  flapping,1  sponge- 
baths,  rain-  or  douche-  or  shower-baths,  sitz-baths,  half- 
baths,  full-baths,  vapor-baths,  river-baths,  sea-baths,  and 
many  mineral  baths;  also  the  application  of  cooling- 
sounds  and  injections  of  cold  water  into  the  urethra 
and  rectum. 

The  action  of  simple  ablutions  is  too  feeble  to  be  of 
much  good  in  any  form  of  impotence.  They  should, 
however,  be  observed  as  a  hygienic  rule  for  cleanliness, 
both  by  the  virile  and  the  impotent.  Ablutions  of  the 
spine  and  loins  act,  nevertheless,  as  a  gentle  stimulus. 
Washing  of  the  spine  and  genitalia  with  spirituous  fluids  is 
common  as  a  domestic  remedy.  Roubaud  recommends 
washing  with  tinctura  nucis  vomicae.  As  a  matter  of 
fact,  I  have  seen  really  good  results  from  the  external 
use  of  tinctura  nucis  vomica?  in  several  cases  of  purely 
neurasthenic  impotence. 

Rubbing  down  and  flapping  are  of  excellent  service,  as 
they  gently  stimulate  the  nerves  and  assist  in  the  assim- 
ilation of  material ;  they  thus  are  indicated  in  several 
forms  of  impotence. 

1  I  would  designate  by  the  name  of  "  flapping"  a  very  important 
and  efficacious  hydropathic  procedure,  which  is  executed  in  the 
following  way  :  a  coarse  sheet,  wet  and  cold,  is  wrapped  around  the 
body  of  the  patient,  the  attendant  slapping  more  or  less  gently.  1ml 
always  rapidly,  the  whole  body  up  and  down  repeatedly  until  the 
skin  is  quite  reddened  and  warm.  A  cold  cloth  is  placed  on  the 
patient's  head  to  avoid  possible  congestion. 

Flapping  is  usually  followed  by  a  cold  half-bath. 


TREATMENT.  247 

Sponge-baths  may  be  substituted  for  shower-baths. 
They  do  not  operate  quite  as  powerfully,  I  admit,  but 
they  are  more  easily  procured,  as  a  round  vessel  not 
overlarge, — a  sitz-bath  tub,  for  instance, — or  a  portable 
rubber  tub  and  a  good  sponge  are  all  that  are  requisite. 

Rain-  and  douche-baths  are  in  many  cases  absolutely 
indispensable.  Applied  generally,  the  shower-bath  as- 
sists powerfully  in  the  assimilation  of  material.  Applied 
locally,  on  the  genitalia  and  spine,  they  operate  as  a 
gentle  stimulant,  acting  directly  on  the  nerves  and  spinal 
cord.  In  certain  conditions  the  douche  filiforme,1  or 
thread-like  shower-bath,  directed  upon  the  glans  is  of 
good  effect. 

In  commonest  use,  however,  are  sitz-baths.  Winter- 
nitz  is  of  the  opinion  that  the  sitz-bath  operates  by 
means  of  a  reflex  stimulation  of  the  nervus  splanchnicus.2 
He  has  made  experiments 3  with  these  baths  and  obtained 
the  following  results :  A  short  sitz-bath,  of  ten  minutes 
and  10°  C.,  causes  a  lowering  of  the  local  temperature, 
which,  however,  is  followed  by  increased  warmth  within 
half  an  hour,  the  reaction  which  ensues  during  the  second 
half-hour  being  followed  by  a  moderate  decrease  in  the 
temperature  for  several  hours.  A  sitz-bath  of  thirty 
minutes  and  of  the  same  temperature  causes  a  dimi- 
nution of  the  temperature  during  a  longer  time  and 
to  a  lower  degree.  The  reaction  sets  in  later,  seems 
less  intense,  and  is  followed  by  a  marked  compensatory 
lowering  of  the  temperature.  Very  long  continued  and 
very  cold  baths  might  postpone  the  reaction  still  more, 

1  Winternitz,  op.  cit.,  Band  i.  p.  35. 

2  Ibidem,  p.  224. 

3  Ibidem,  Band  ii.  p.  139,  etc. 


248  SEXUAL  IMPOTENCE. 

and  possibly  prevent  it  altogether.  Either  short  or  pro- 
longed .silx-haths  of  a  fempcralure  approaching  that  of 
the  blood  warm  the  rectum  directly.  The  most  important 
therapeutic  results  arc  obtained  by  hip-baths  of  20°  C. 
They  usually  cause  no  subsequent  warming  of  the  rectum, 
but  constantly  show  a  lowering  of  the  temperature  in 
the  rectum. 

Hence  short,  cold  sitz-baths  must  be  considered  as 
an  exciting,  stimulating  form  of  bathing,  whilst  cold  sit/- 
baths of  longer  duration  induce  depression  and  retard 
the  process  of  local  nutrition  and  heighten  the  vascular 
tonicity  in  the  pelvic  organs.  Warm  and  hot  sitx-baths 
have  a  relaxing  effect.  Temperate  sitx-baths,  18°  to  25° 
C.,  are  antiphlogistic.  The  cold  sitx-bath  is  of  main 
utility,  and  should  be  of  a  shorter  or  longer  time  ac- 
cording as  a  stimulating  or  sedative  effect  is  intended. 

Of  similar  but  more  powerful  effect  are  the  so-called 
half-baths,  which,  along  with  the  ordinary  cold  baths, 
must  be  considered  as  exciting,  if  they  are  not  of  too 
long  duration,  which  is  not  likely  to  be  the  case.  Very 
excellent  results  for  the  purpose  of  curing  several  forms 
of  impotence  in  which  stimulation  is  indicated  are  ob- 
tained by  half-baths  of  12°  to  18°  C.,  combined  with 
friction  and  showers  during  bathing. 

Even  vapor-baths  may  be  indicated  in  many  cases  of 
impotence ;  these  have  also  a  stimulating  action,  and, 
moreover,  prevent  the  formation  of  adipose  tissue. 

The  most  stimulating  form  of  bathing  is  /-mr-iW/////// 
and  sea-bathing,  which  often  perform  real  miracles  with 
the  impotent.  Milder  forms  of  impotence  are  very  fre- 
quently cured  by  river-bathing  alone,  and  still  better  by 
sea-bathing.  In  these  baths  there  is,  besides  the  thermal 
stimulus,  an  exceedingly  strong  mechanical  excitation  by 


TREATMENT.  249 

the  action  of  the  flowing  water  and  of  the  dashing  of  the 
waves.  For  river-bathing  are  to  be  preferred  those  rivers 
or  parts  of  rivers  which  present  a  moderate  depth  com- 
bined with  a  strong  and  rapid  current,  and,  likewise,  for 
sea  bathing,  places  where  the  billowing  is  strong.  Very 
great  care  must  be  taken  in  prescribing  these  forms  of 
bathing,  because  patients  that  are  run  down  and  many 
neurasthenics  cannot  endure  them  very  well.  Bathing 
in  stagnant  waters,  as  in  lakes,  has  also  a  good  effect 
sometimes.  It  may  be  a  thermal  stimulus,  and  the 
movements  made  in  the  bath  contribute  to  the  accelera- 
tion of  the  elaboration  of  matter.  Protracted  bathing  in 
warm  water  is  scarcely  ever  desirable. 

The  balneological  treatment  is  merely  in  its  inceptive 
stage ;  but  we  know  that  soda  and  sulphurous  waters  do 
very  good  service  in  nearly  every  form  of  impotence. 
The  sulphur  waters  were  recommended  by  French  au- 
thors as  early  as  Lallemand's  time.  I  have  occasionally 
noticed  a  favorable  influence  on  the  sexual  life  of  patients 
who  used  sulphurous  thermae  for  other  causes.  I  have 
frequently  ordered  with  best  results  bathing  in  natural 
salt-water,  and  also  in  artificial  mineral  salt  or  rock-salt 
water. 

Bathing  in  other  mineral  waters  is  advisable  for  those 
forms  of  impotence  in  which  some  specific  mineral  water 
treatment  will  remove  causes  of  impotence,  as,  for  in- 
stance, prostration,  anemia,  torpid  digestion,  etc. 

The  Winternitz  cooling-sound,  psychrojihor,  is  an  un- 
fenestrated  catheter  a  double  courant.  Its  application 
is  adaptable  in  the  treatment  of  all  the  forms  of  im- 
potence connected  with  hyperesthesia  of  the  urethra, 
especially  of  the  colliculus  seminalis.  The  instrument 
is  introduced  as  far  as  the  neck  of  the  bladder,  and 


250  SEXUAL  IMPOTENCE. 

sometimes  into  the  bladder.  A  continuous  stream  of 
cold  water  flows  through  it,  so  that  to  the  mechanical 
stimulus  of  the  sound  is  added  the  effect  of  the  cold. 
The  psychrophor  is  borne  even  by  patients  in  whom 
the  sound  cannot  be  introduced  at  all,  or  not  often 
enough,  on  account  of  the  violent  pain  produced. 

Simple  injections  of  cold  water  into  the  urethra  are 
very  efficacious  on  account  of  the  mechanical  stimula- 
tion and  the  effect  of  the  cold  combined.  The  effect  of 
such  injections  is  merely  exciting,  whilst  the  psychrophor 
may,  according  to  the  duration  of  the  application,  have  a 
depressing,  even  an  antiphlogistic,  action.  The  injection 
of  cold  water  into  the  urethra  is  made  use  of,  as  I  have 
noticed,  by  sailors  as  a  means  of  temporary  excitation 
after  long  continence,  and  I  wonder  that  we  never  n  ;nl 
of  this  practice  in  mediml  lilorature. 

In  order  to  act  upon  the  prostatic  part  of  the  urethra 
we  may  in  some  cases  make  use  of  Azpcr(/cr'^  ,-<'<-t<il 
cooling  sound1  or  of  Winternitz's  rectal  cooling  po/ic/i.- 
The  action  is  similar  to  that  of  the  psychrophor,  whilst 
cold-water  injections  into  the  rectum  act  as  do  those 
made  into  the  urethra. 

Application  of  dry  warmth  or  cold  has  a  similar  action 
to  that  of  hydro-therapeutic  stimulation.  Very  consider- 
able stimulation  can  be  obtained,  particularly  if  high  and 
low  temperatures  are  applied  alternately,  Roubaud  ' 
recommends  a  syringe  for  the  application  of  hot  air. 

Many  newspapers  have  advertised  the  carbon-dmn-lir. 
In  the  application  of  this  remedy  the  genitalia  arc.  by 

1  Winternitz,  op.  cit.,  Band  ii.  p.  129. 

2  Ibidem,  p.  131. 

3  Traite  de  1'impuissance.     Paris,  1876,  p.  146. 


TREATMENT.  251 

moans  of  a  peculiarly  constructed  apparatus,  exposed 
to  the  direct  action  of  carbonic  acid  gas.  This  action, 
though  mildly  stimulating,  I  consider  has  more  of  a 
psychical  effect  or  influence.  The  external  application 
of  carbonic  acid  gas  has  already  been  recommended  by 
Bernatzik,1  and  quite  recently  by  B.  Schuster  in  Nau- 
heim.2  The  latter  found  it  highly  effective  in  cases  of 
neurasthenic  lessening  of  libido  and  erectility  and  in 
premature  senile  impotence.  I  saw  very  little  effect  in 
the  few  cases  in  which  I  have  made  use  of  it.  Carbonic 
acid  may  have  a  better  effect  in  female  diseases. 

The  different  kinds  of  electrical  currents  are  made 
use  of  in  the  treatment  of  impotence  quite  as  often  as 
the  various  procedures  of  hydro-therapeutics.  Every 
kind  of  current  has  its  advocate  among  the  different 
authors,  and  every  one  extols  the  method  he  uses. 
This  fact  alone  would  be  enough  to  prove  that  science 
has  not  yet  reached  its  zenith  in  reference  to  the  appli- 
cation of  these  electrical  currents. 

Erb3  states  in  plain  words  that  nothing  is  known 
about  the  electro-physiological  action  upon  the  testicles 
and  vasa  deferentia  of  the  living  man,  and  that  the 
knowledge  of  the  effect  on  the  spinal  cord  is  also  very 
scanty.  We  must  rely  entirely  on  empiricism,  or  prac- 
tical experience,  and  this  teaches  us  that  electricity,  in 
whatever  way  it  may  be  applied,  is  of  excellent  service 
in  special  forms  of  impotence,  but  that  there  are  many 


1  Aphrodisiaca,  Eulenburg's  Real-Encyclopadie.    Wien  und  Leip- 
zig, 1885,  Band  i.  p.  614. 

2  XVII.  Versammlung  der  balneol.  Gesellsch.  in  Berlin,  1896. 

8  Elektrotherapie.    Ziemssen's  Handbuch  der  allgemeinen  Thera- 
pie,  Band  iii.  p.  128. 


252  si: \r.\L  IMPOTKNCE. 

cases  where  it  is  of  no  use,  or  may  even  do  harm.  A 
careful  distinction  of  the  sundry  eases  and  a  thorough 
investigation  as  to  which  arc  proper  for  electrical  treat- 
ment is  more  necessary  than  in  any  oilier  mode  of  treat- 
ment. Only  a  thoroughly  correct  application  can  suffi- 
ciently reward  our  efforts  by  good  results,  and  it  is  of 
the  utmost  importance  to  know  what  kind  of  current  is 
to  be  chosen,  of  what  strength  it  should  be,  and  in  what 
way  applied.  This  necessitates  a  careful  study  of  each 
individual  rase,  with  all  its  accompanying  details  or  cir- 
cumstances. 

The  (/(i/nniic  cnrrcni  will  be  indicated  most  frequently. 
We  commence  by  localizing  the  electricity,  applying  the 
zinc  pole  over  the  cord  in  the  lumbar  region,  and  the 
copper  pole  to  the  upper  and  under  surfaces  of  the 
penis,  to  the  testicles,  perineum,  and  the  spermatic  cord 
downward  from  the  inguinal  ring.  In  other  cases. 
when  the  spinal  cord  is  to  be  operated  upon,  the  copper 
pole  is  applied  to  the  nucha,  and  the  zinc  pole  to  the 
region  of  the  lumbar  vertebrae.  A  more  powerful  action 
is  obtained  if  the  copper  pole  is  applied  to  the  lumbar 
region  and  the  zinc  pole  to  the  perineum  or  to  the  pars 
prostatica  by  means  of  the  bladder  rheophore.  A  still 
stronger  effect  is  produced  by  the  introduction  of  the 
copper  pole  into  the  rectum  by  means  of  the  rectal 
iheophore,  and  the  zinc  pole  as  far  as  the  pars  pros- 
tatica. Only  weak  currents,  however,  can  be  applied, 
and  but  once  a  week,  as  a  more  frequent  application 
might  induce  inflammation  of  the  mucous  membrane. 

In  the  use  of  the  bladder  rheophore  Lewandowski1 

1  Elektrodiagnostik   und    Electrolherapie.      Wien    mid    Leipzig, 
1887,  p.  410. 


TREATMENT.  253 

recommends  the  gradually  increasing  faradic  current  or 
very  short  interruptions  in  the  application  of  the  cur- 
rent. Besides,  both  poles  may  be  applied  externally 
along  the  course  of  the  spermatic  cords,  when  inter- 
ruptions and  reversing  of  the  current  are  particularly 
effective.  It  must  always  be  borne  in  mind,  however, 
that  an  energetic  electrical  treatment  can  be  of  service 
only  to  individuals  of  very  low  electrical  irritability. 

The  time  of  application  will  have  to  be  longer  or 
shorter  as  the  different  cases  may  require.  If  the  pa- 
tient is  not  affected  with  anesthesia  of  a  high  degree,  or 
if  the  electrical  irritability  begins  to  return  during  the 
treatment,  erections  may  occur  even  during  the  applica- 
tion, and  this  would  very  much  raise  the  courage  and 
confidence  of  the  patient. 

The  manner  of  application  of  the  faradic  current  is 
the  same  as  that  of  the  galvanic ;  but  the  induced  cur- 
rent is  not  so  frequently  used  for  electrizing  the  spinal 
cord  itself.  By  means  of  the  metallic  brush  the  glans 
and  the  testicles  are  directly  excited  rather  strongly. 
Such  an  application  produces  a  reddening  of  the  skin, 
and  serves  therefore  as  a  stimulant  to  the  circulation  of 
the  blood  in  the  parts  in  question  to  a  higher  degree 
than  any  other  method  of  applying  electricity. 

If  one  pole  is  introduced  into  the  rectum  to  the  height 
of  the  vesicula?  seminales,  while  the  metallic  brush  fara- 
dizes  the  testicles  and  the  entire  surface  of  the  penis,  an 
erection  may  very  often  be  produced  during  the  treat- 
ment, as  Onimus1  remarks,  and  this  fact  has  also  been 
observed  by  myself. 

Especially  to  be  recommended  is  the  application  of 

1  Guide  pratique  d'Electrotherapie.     Paris,  1882,  p.  264. 


254  SKXTAL    IMI'OTK.NVK. 

weak  induction  currents  dnrini:  a  longer  lime,  because 
lhc\  are  apt  lo  revive  the  cxcilaliilil y  of  weakened  nerves, 
as  has  boon  demonstrated  by  von  Be/old  and  Kn^elniann. 

Static  electricity,  franklinization*  or  ^eneml  eleHri- 
zation,  is  yet  in  rare  use,  although  very  good  results 
have  been  obtained  thereby  in  recent  times.  Eulen- 
burg2  asserts  that  carefully  watched  hydro-electric  bal  I  is. 
electro-static  air-baths,  etc.,  are  preferable  to  the  pro- 
cess of  general  faradization  and  galvanization  as  indi- 
cated by  Rockwell  and  Beard,  because  I  he  I  alter  are  too 
complicated,  cause  loss  of  time,  and  are  somewhat  im- 
perfect in  their  effect. 

Hydro-electric  baths3  and  general  franklinizalinii  will) 
the  influence  machine  will  be  positively  indicated  in 
impotence  dependent  upon  constitutional  diseases,  dis- 
turbances in  the  general  nutrition,  or  states  of  weakness, 
but  most  of  all  in  those  forms  brought  about  by  general 
neurasthenia. 

Next  to  the  treatment  of  impotence  by  electricity 
comes  the  local  treatment  oftenest  employed,  which 
has  again  come  into  vogue. 

In  the  first  place  comes  local  cauterization.  Modern 
physicians  have  simply  returned  to  Lallemand's  method 
of  treatment,  which  has  been  so  much  criticised.  The 
principle  has  remained  the  same,  the  mode  of  application 
only  having  somewhat  changed.  I  do  not  venture  to  say 
whether  it  is  for  the  better,  but  prefer  to  discuss  Lalle- 
mand's  method  briefly. 

1  Stein,   Die    allgemeine    Elektrisation    des   menschl.   Korpers. 
Halle,  1883. 

2  Sexuelle  Neuropathic.     Leipzig,  1895,  p.  40. 

3  Eulenburg,  Die  hydroelektrischen  Bader.     Wien  und  Leipzig, 
1883,  p.  76. 


TREATMENT.  255 

Lallemand  cauterized  the  caput  gallinaginis  with  a 
lapis-style  or  caustic-holder  that  formed  part  of  a  spe- 
cially constructed  instrument.  To  handle  successfully 
Lallemand's  instrument  requires  a  certain  dexterity 
which  can  be  acquired  only  by  practice  ;  but  when  this 
dexterity  is  once  acquired,  the  extent  of  the  cauterization 
can  be  limited  at  will.  Any  one  who  has  become  skilled 
in  Lallemand's  method  of  cauterization  will  prefer  it  to 
all  others,  with  the  exception  of  the  more  simple  method 
of  cauterizing  with  the  endoscope. 

Every  one  will  soon  convince  himself  that  such  bril- 
liant and  prompt  results  as  we  read  of  in  Lallemand's 
wonderful  work  cannot  be  obtained  in  our  days  by  any 
method  of  cauterization  that  may  be  adopted.  The 
method  has  remained  the  same,  man  is  the  same,  and 
the  nature  of  the  disease  is  still  the  same  as  in  Lalle- 
mand's time.  The  difference  between  our  results  and 
those  of  Lallemand  can  be  explained  by  the  fact  that  we 
are  not  the  inventors  of  this  method  of  treatment,  and 
are  therefore  able  to  look  upon  our  results  with  greater 
impartiality.  It  will  enter  no  one's  mind  to  accuse  Lal- 
lemand of  having  intentionally  distorted  the  facts  ;  but 
every  one  can  easily  understand  that  Lallemand,  who 
had  correct  ideas  of  the  conditions  in  the  urethra  long 
before  the  endoscope  came  into  existence,  would  see 
only  the  successful  results  of  his  method,  and  give  little 
or  no  attention  to  his  failures ;  also,  that  he  overesti- 
mated the  value  of  his  invention.  His  brilliant  success 
can  be  understood  when  we  consider  that  in  his  time 
Lallemand  was  the  only  physician  of  renown  who  did 
not  think  it  below  his  dignity  to  occupy  himself  with  the 
different  forms  of  sexual  weakness ;  so  that,  as  a  natu- 
ral consequence,  people  of  the  wealthy  class  suffering  or 


256  SEXUAL  IMPOTENCE. 

imagining  themselves  to  suffer  from  sexual  weakness 
would  Mock  to  him  from  far  and  near.  Comparing  the 
number  of  psychically  impotent  with  those  that  are 
all'eded  with  real  impotence,  we  shall  find  that  the  for- 
mer constitute  the  larger  portion  of  those  applying  for 
relief.  Now  with  these  neurasthenics  Lallemand's  fame, 
combined  \\ith  the  great  renown  of  his  method,  must 
have  exercised  a  curative  influence.  Finally,  we  must 
not  forget  that  great  minds  are  not  without  a  weakness 
or  a  hobby.  I  have  a  vivid  recollection  of  a  worthy 
clinician  who  died,  unfortunately,  too  early.  This  gentle- 
man thought  he  had  discovered  at  one  time  a  great  epi- 
demic of  cerebro-spinal  meningitis,  and  he  became  quite 
angry  when  his  assistant  merely  sought  for  another  ex- 
planation of  the  symptoms.  When  he  had  to  treat  ob- 
slinale  patients  who  positively  refused  to  show  cutaneous 
hyperesthesia,  he  would  pinch  their  skin,  so  as  to  pro- 
duce for  his  own  satisfaction  utterances  of  pain  which 
would  indicate  to  him  the  existence  of  hyperesthesia. 

Many  German  physicians  took  umbrage  at  the  fact 
that  they  could  not  obtain  the  same  brilliant  results  as 
Lallemand.  and  rejected  his  method  altogether.  In  the 
eyes  of  other  investigators  Lallemand  had  presumed  too 
much  through  his  mania  for  writing.  Although  Lalle- 
mand has  really  treated  the  whole  question  too  broadly, 
every  one  will  prefer  his  prolixity  to  the  scant  treat  in  en  I 
given  to  the  subject  by  many  authors  of  the  present 
time.  Of  course,  we  no  longer  accept  many  of  Lalle- 
mand's views ;  as,  for  instance,  his  exaggerated  idea  of 
the  effect  on  the  sexual  power  of  riding,  of  tobacco, 
coffee,  and  tea.  This,  however,  does  not  alter  the  fact 
that  cauterizing  after  Lallemand's  method  does  excel- 
lent service  in  pollutions,  spermatorrhea,  or  impotence 


TREATMENT.  257 

caused  by  changes  in  certain  portions  of  the  urethra. 
The  endoscope  enables  us  now  to  obtain  positive  knowl- 
edge about  this  cause. 

Special  care  must  be  taken  in  cauterizing,  and  it  should 
be  undertaken  only  by  medical  men  who  are  perfectly 
familiar  with  the  handling  of  the  endoscope,  and  by 
them  only  under  the  control  of  this  instrument.  Cau- 
terizing is  thereby  much  facilitated,  the  need  of  a  caustic- 
holder  being  dispensed  with,  since  a  lapis-style  fastened 
on  a  piece  of  silver  wire  answers  the  purpose  perfectly. 
The  majority  of  physicians  have  for  the  endoscope  a 
certain  objection  which,  says  Griinfeld,  can  exist  only  on 
the  ground  of  their  ignorance  in  regard  to  the  details. 
This  one  application  of  the  instrument  should  suffice  to 
make  its  utility  obvious  to  every  thinking  man. 

The  aero-endoscope  of  Antal  is  excellent,  but,  I  regret 
to  say,  cannot  be  used  for  cauterizing.  Good  service  is 
obtained  from  an  endoscope  of  Griinfeld,  made  of  hard 
rubber  and  of  sufficient  length.  At  present  I  use  only 
Nitze's  endos'cope,  with  its 'modifications  by  Oberlarider 
and  Kollrnann.  "  The  light  is  furnished  by  a  platinum 
wire  made  incandescent  by  the  electric  current  with 
which  it  is  connected  by  conducting  wires.  The  wire 
is  introduced  to  near  the  visceral  end  of  the  tube  and 
throws  a  strong  light  upon  the  exposed  portion  of  the 
mucous  membrane."  This  instrument  is  the  best  at 
our  disposal,  though  I  can  only  agree  with  Klotz1  when 
he  says  that  "  Kollmann's  instrument  is  by  no  means  free 
from  objectionable  features  and  is  certainly  not  as  perfect 
as  has  been  claimed." 


1  Klotz,  The  Practical  Use  of  the  Endoscope.     Journal  of  Cuta- 
neous and  Genito-Urinary  Diseases.    New  York,  July,  1898,  p.  313. 

17 


258  SEXUAL   IMF'OTK.NTI-:. 

Immediately  before  UK-  operation  of  cauterizing,  the 
bladder  should  be  completely  emptied.  One  reason  is 
to  spare  the  patient  Hie  intense  pain  that  would  be  in- 
duced by  urinating  soon  after  the  operation,  and  another 
to  prevent  the  risk  of  having  the  effect  of  cauterizing 
very  much  interfered  with  by  an  involuntary  discharge 
of  urine  whilst  the  operation  is  going  on.  Nowadays 
it  hardly  seems  necessary  to  mention  any  reasons,  as 
no  competent  physician  will  introduce  any  kind  of  an 
instrument  into  the  urethra  without  first  having  the 
bladder  emptied  and  disinfecting  the  urethra  itself. 

The  eye  of  the  operator  will  guide  him  as  to  the  ex- 
tent of  the  cauterization,  which,  of  course,  will  be  de- 
termined by  the  pathological  changes  he  observes,  but 
in  any  case  the  cauterization  must  be  confined  within 
reasonable  limits. 

Lallemand1  orders  that  after  cauterization  the  patient 
is  to  bathe  frequently  during  the  first  few  days  ;  he  must 
cause  regular  defecation  by  clysters,  and  he  must  lake 
light  food,  consisting  of  milk  and  vegetables.  Again,  he 
must  avoid  all  bodily  exertion  and  exposure  to  cold. 

During  the  first  two  or  three  days  following  cauteri- 
zation there  is  dysuria,  and  the  urine  contains  a  few 
drops  of  blood.  In  cases  of  particularly  intense  inflam- 
mation ice-bags  may  be  applied  to  the  perineum.  If  the 
pain  is  great,  it  may  be  relieved  by  the  use  of  opium. 
A  repetition  of  the  use  of  the  cautery  cannot  be  thought 
of  until  all  symptoms  of  inflammation  have  subsided. 
Lallemand  thinks  this  will  take  a  couple  of  weeks. 

A  similar  although  more  feeble  effect  may  be  obtained 
by  the  use  of  astringent  injections.  I  have  already  had 

1  Op.  cit.,  tome  iii.  p.  401. 


TREATMENT.  259 

occasion  to  state  that  injections  of  cold  water  exert  a 
certain  stimulating  influence,  being  frequently  followed 
by  erections.  Astringents  cause  a  stronger  irritation, 
and  the  stimulation  is  in  direct  proportion  to  the  strength 
of  the  injection. 

Astringents  for  local  excitation  may  be  used  also  in 
the  form  of  gelatin  bougies.  Dittel  has  had  constructed 
a  special  porte-remede,  by  means  of  which  he  applies  to 
the  pars  prostatica  astringents  in  the  form  of  small 
n  rcfli  rdl  suppositories. 

Ultzmann  has  invented  a  urethral  dropper  for  apply- 


ing any  astringent  fluid  or  caustic  to  deeper  portions  of 
the  urethra.  A  physician  handling  the  endoscope  can 
dispense  Avith  these  instruments  in  the  treatment  of 
impotence  if  no  special  obstacle  interfere  with  its  in- 
troduction. Any  difficulty  in  the  introduction  of  the 
endoscope  will  also  interfere  with  the  introduction  of  the 
other  instruments. 

Zinc,  alum,  copper,  or  tannin  may  be  used  in  the 
urethral  injections.  I  especially  recommend  tinetura 
rutanhice,  which  can  be  used  in  solutions  of  different 
strength.  'One  drop  of  pure  tinetura  ratanhiae  (Krameria 
triandra)  on  the  pars  prostatica  has  the  same  effect 
as  one  cauterization  without  any  of  the  objectionable 
consequences  that  follow  the  latter  procedure.  Weak 
solutions  of  astringents  can  be  injected  with  any  ordi- 
nary urethral  syringe.  Stronger  solutions  had  better  be 
applied  locally  under  the  safe  guidance  of  an  endoscope. 

Very  good  results  are  obtained  in  certain  cases  of  im- 
potence that  accompany  chronic  gonorrhea  and  its  com- 
plications by  the  use  of  intravesical  irrigations.  These 
can  be  performed  thoroughly  and  easily  with  Valentine's 
intravesical  irrigator. 


260  SKMAL    I.MI'UTKM'K. 

The  introduction  of  flexible  hoiit/irx  or  •inrtu/  *t>niitlN 
iii;iy  lie  indicated  in  ;i  ^rcal  many  cases,  and  was  ad- 
vised by  Lallemand.  Special  results  arc  obtained  in  hy- 
peresthetic  conditions  of  the  urethra  and  the  prostala. 
In  such  cases  the  introduction  of  a  bougie  or  sound  is 
accompanied  by  so  much  pain  I  hat  the  patient  can  with 
difficulty  he  induced  to  submit  to  a  second  introduction. 

In  cases  of  intense  Hyperesthesia  it  is  best  to  be-in 
with  the  insertion  of  flexible  bougies  as  gently  as  pos- 
sible. If  the  procedure  is  repeated  daily,  the  hyperes- 
thesia  decreases  markedly  and  gradually  admits  of  the 
use  of  metal  sounds.  This  would  show  that  the  treat- 
ment by  sounds  or  bougies  is  of  particularly  good  ef- 
fect, especially  in  cases  of  precipitate  ejaculation  and  of 
too  frequent  pollutions.  The  idea  is  probably  quite  cor- 
rect that  by  the  introduction  of  a  heavy  metal  sound 
pressure  and  tension  are  produced  in  the  pars  prostatica, 
thus  causing  a  stimulation  and  possibly  an  erection  ; ' 
but  this  is  of  no  particular  value  in  the  course  of  the 
treatment  of  impotence,  because  it  soon  loses  its  effect. 
In  certain  cases  it  may  be  useful  as  a  temporary  harm- 
less excitant. 

During  recent  years  I  have  almost  exclusively  used 
metal  sounds,  because  experience  has  taught  me  that 
after  sufficient  dexterity  is  acquired  it  is  easier  to  insert 
a  steel  sound  than  a  flexible  bougie  in  cases  of  hyperes- 
thesia  of  a  high  degree.  When  using  a  metal  sound 
force  is,  of  course,  to  be  avoided,  and  the  sound  must  be 
guided  by  the  anatomy  of  the  parts,  and  must  be  carried 
practically  by  its  own  weight  into  the  bladder.  In  with- 

1  Ultzmann,  Ueber  Potentia  generandi  und  Potentia  coeundi. 
Wiener  Klinik,  1885,  Heft  1. 


TREATMENT.  261 

drawing  the  sound  the  free  hand  must  take  hold  of  the 
penis  close  to  the  meatus,  and  by  gentle  downward 
pressure  protect  the  urethra  from  strain  that  might  be 
induced  by  the  escaping  sound. 

Many  authors  and  most  practitioners  recommend  ex- 
tcriKil  a  ft  i>1i  cations  to  the  genitalia  of  various  substances, 
such  as  tinctura  nucis  vomicse,  eau  de  Cologne,  alcohol, 
etc.  It  is  not  to  be  denied  that  such  applications  in- 
crease for  the  time  being  the  vascularity  of  the  parts  in 
question,  and  that  the  cutaneous  nerves  may  thereby  be 
for  the  moment  excited.  At  any  rate,  the  effect  cannot 
be  great,  and  therefore  they  may  be  ordered  sometimes 
"  ut  aliquid  fiat,'1  especially  in  cases  when  the  patient's 
uneasiness  must  be  appeased.  Concerning  the  tinctura 
nucis  vomicae  recommended  by  Roubaud,1  it  would  be 
interesting  to  ascertain  whether  some  of  it  is  absorbed 
through  the  skin  of  the  glans. 

We  cannot  approve  of  the  application  of  sinapisms 
to  the  genitalia  as  recommended  by  Roubaud  ;  because 
the  least  incautious  management  may  do  harm,  and  be- 
cause no  benefit  can  be  derived  from  an  erection  pro- 
duced by  such  a  painful  remedy. 

We  do  not  mean  to  waste  more  than  a  word  here  on 
acupuncture  and  elect  ropuncture.  They  were  formerly  in 
use  ;  were  recommended  by  Lallemand,  and  in  recent 
times  by  Roubaud  ;  but  no  one  nowadays  would  enter- 
tain the  idea  of  indulging  in  such  a  procedure. 

Local  surgical  operation  must  of  course  be  adopted, 
when  possible,  for  the  removal  of  defects.  The  most 
frequently  indicated  operations  are  circumcision  and  the 
gradual  dilation  of  strictures. 

1  Op.  cit.,  p.  154. 


262  SEXUAL  IMPOTENT!-]. 

The  application  of  massage,  general  as  well  as  local, 
and  of  gymnastics,  may  in  many  cases  of  impotence 
bring  about  very  satisfactory  results,  especially  when 
it  is  necessary  to  strengthen  the  body  and  to  further 
assimilation. 

General  massage  of  the  body,  the  Swedish  move- 
ments, and  our  ordinary  gymnastics  can  be  used  only 
with  reasonable  moderation.  I  do  not  think,  however, 
I  hat  systematic  exercise,  even  if  carried  to  athleticism, 
can  in  any  wise  have  an  unfavorable  influence  on  the 
sexual  power,  as  is  often  stated.  If  some  athletes  are 
really  disinclined  to  enjoyments  in  venery,  the  explana- 
tion is  found  in  the  fact  that  an  occupation  monopo- 
lizing time  and  causing  bodily  fatigue  is  not  conducive 
to  sexual  pleasure.  I  have  known  some  athletes  who  by 
no  means  despised  sexual  enjoyments.  The  idea  -that 
athletes  are  weak  sexually  probably  arose  from  the  fact 
that  among  the  ancient  Grecians  all  athletes  were  com- 
pelled to  abstain  from  coition  as  much  as  possible.1 

Substitutes  for  gymnastics  proper  are  such  other  bo<li/i/ 
exercises  as  riding,  skating,  etc. ;  and  bicycling  is  to  be 
recommended  particularly.  Lallemand2  has  said,  "  The 
action  of  the  lower  limbs  has  probably  more  of  a  direct 
influence  upon  the  sexual  organs.'1  Of  course,  even 
these  exercises  must  not  be  carried  to  the  point  of 
fatigue. 

In  some  cases  traveling  may  have  marked  effect.  An 
interesting  journey,  and  especially  if  made  on  foot,  in 
part  at  least,  is  beneficial;  it  engages  the  mind  and 


1  Busch,    Allgemeine    Orthopadie,    Gymnastik    und 
Ziemssen,  Allg.  Therap.,  Band  ii.  Tlicil  2,  p.  20. 

2  Op.  cit ,  tome  iii.  p.  384. 


TREATMENT.  263 

draws  the  patient  away  from  bad  company  or  from  un- 
desirable conditions.  Many  patients  have  returned  per- 
fectly cured  from  a  proper  journey.  Voyages  also,  if 
not  of  excessive  length,  do  very  excellent  service  in 
proper  cases,  and  especially  in  those  where  abstinence 
is  positively  indicated. 

The  flagellations  that  were  known  in  ancient  times,1 
and  at  one  epoch  enrolled  in  religious  service,  "  la  Dis- 
cipline d'enhaut  et  la  Discipline  d'enbas,"2  are  in  some 
sense  a  kind  of  massage.  They  are  appropriated  in  our 
days  by  physically  ruined  debauchees  as  a  means  of 
stimulating  the  exhausted  spinal  cord.  Ancient  authors 
have  a  peculiar  explanation  for  the  stimulating  influence 
of  flagellations;  for  instance,  Boileau:3  "  Cela  pose,  il 
faut  de  toute  necessite,  que  lors  que  les  muscles  lom- 
baires  sont  frapez  a  coup  de  verges,  ou  de  foiiet,  les 
esprits  animaux  soient  repoussez  avec  violence  vers  1'os 
pubis,  et  qu'ils  excitent  des  mouvements  impudiques,  a 
.cause  de  la  proximite  des  parties  genitales :  Ces  impres- 
sions passent  d'abord  au  cerveau,  et  y  peignent  de  vives 
images  des  plaisirs  defendus,  qui  fascinent  1'esprit  par 
leurs  charmes  trompeurs,  et  reduisent  la  chastete  aux 
derniers  abois." 

Our  explanation  of  the  effect  of  these  flagellations 
differs  considerably  from  the  above.  Besides,  we  must 
dispense  with  these  means  of  treatment.  In  some  cases 
we  may  apply  along  the  spine  different  aromatic  and 
irritative  substances,  which  cause  a  local  hyperemia  and 


1  Roubaud,  op.  cit.,  p.  151. 

2  Histoire  des  Flagellans,  traduite  du  Latin,  de  M.  1'Abbe  Roileau. 
Amsterdam,  1701,  p.  5. 

3  Histoire  des  Flagellans,  p.  307. 


264  SEXUAL  IMPOTENT!-:. 

are  good  substitutes  for  the  flagellations.  We  shall  take  no 
notice  ofurticafion,  inoxa,  vesicatories,  and  similar  things. 

Professional  and  other  inventors  have  always  endeav- 
ored to  construct  apparatus  and  instruments  designed 
either  to  remove  sexual  impotence  itself  or  to  enable 
the  impotent  to  introduce  the  non-erected  or  only  par- 
tially erected  penis  into  the  vagina.  I  refer  here  to  the 
paradoxical  apparatus  for  the  pretended  enlargement 
of  the  penis  by  Roubaud,  who  has  found  no  imitators ; 
to  the  so-called  "  ventouse"  by  Mondat,  mentioned  also 
by  Roubaud ;  and  to  numerous  other  devices  that  are 
almost  useless. 

The  first  step  in  a  practical  direction  -was  made  by  an 
inventor  unknown  to  me,  who  constructed  a  small  in- 
strument in  which  a  flourishing  trade  was  carried  on 
for  a  while,  and  which  I  described  in  the  first  edi- 
tion of  my  "  Pathology  and  Therapy  of  Sexual  Impo- 
tence." There  existed  at  that  time  also  medical  moral- 
ists who  declaimed  against  such  instruments ;  but,  in 
spite  of  this,  I  was  confirmed  in  my  opinion,  expressed 
at  that  time,  that  even  a  conscientious  physician  in  cases 
especially  worthy  of  regard,  and  when  every  other 
remedy  had  failed,  could  take  upon  himself  the  respon- 
sibility of  advising  the  use  of  such  an  instrument. 
Shortly  after  the  appearance  of  my  work,  letters  from 
every  part  of  the  world  came  to  me  from  physicians  in- 
quiring concerning  the  instrument.  I  was  not  in  a  posi- 
tion to  advise  them  as  to  where  to  obtain  it,  as  the  one 
I  had  came  to  me  through  a  patient. 

The  instruments  were  made  of  German-silver,  silver, 
or  gold,  and  consisted  of  two  delicate  splints  connected 
at  the  base  by  a  metal  ring,  and  at  the  upper  end  by  a 
soft-rubber  ring.  In  the  jargon  of  elderly  bon-vivants  it 


TREATMENT.  265 

used  to  be  called  "  the  sledge,"  and  fairly  fulfilled  its 
purpose,  when  made  exactly  to  measure,  in  spite  of  con- 
siderable inconvenience  arising  from  the  fact  that  the 
penis  is  not  supported  at  the  base,  and  that  the  instru- 
ment certainly  cannot  remain  unnoticed  and  unfelt  by 
the  female  partner. 

The  various  chains,  belts,  plates,  and  other  contriv- 
ances which,  as  Fiirbringer  says,  bring  to  mind  the 
amulets  of  old,  we  shall  not  consider  at  all,  as  they  are 
calculated  solely  to  abuse  the  ignorance  and  credulity  of 
the  masses,  and  are  of  greater  utility  to  the  rascally 
vender  than  to  the  gullible  purchaser.  A  real  progress 
in  the  direction  of  the  mechanical  treatment  of  sexual 
impotence  is  shown  by  Paul  Gassen's  devices.  This 
"  erector1'  consists  of  a  doubly  coiled  spiral  provided  at 
both  ends  with  knob-like  masses.  The  instrument  is 
twisted  round  the  member  in  such  a  manner  that  the 
greater  button-like  extremity  is  placed  in  the  region  of 
tlie  anus,  the  smaller  one  on  the  right  side  of  the  frenu- 
lum.  The  first  turn  will  consequently  be  placed  on  the 
dorsal  side  of  the  bases  of  the  penis,  enabling  it  to  exer- 
cise pressure  on  the  vena  dorsalis,  thus  checking  the 
reflux  of  blood  from  the  corpora  cavernosa. 

The  interest  of  European  physicians  for  these  instru- 
ments was  awakened  through  Krafft-Ebing's l  expert 
opinion,  as  well  as  Flirbringer's 2  article  in  the  u  Zeitschrift 

1  Gerichtliches  Gedachten  iiber  ein  von  dem  Techniker  Paul  Gas- 
sen  erfundenes  Instrument  zur  Behebung  der  Impotenz,  genannt 
Erector.    Friedreich's  Blatter  fur  gerichtliche  Medicin  und  Sanitat- 
spolizei,  1897,  Heft  3,  p.  217. 

2  Zur  diatetischen  und  physikalischen  Behandlung  der  Impo- 
tence.   Zeitschrift  fur  diatetische  und  physikalische  Therapie,  1898, 
Band  I.  Heft  1. 


266  SEXUAL  IMPOTENCE. 

fur  diatetische  und  physikalische  Therapie,"  and  numer- 
ous experiments  on  the  subject  followed. 

I  shall  first  give  the  views  of  these  and  some  other 
authorities  on  the  subject,  and  then  the  results  of  my 
own  experience. 

KralTl-Kbing,  in  his  well-known  opinion,  given  as  an 
expert  before  the  royal  court  of  justice  of  Cologne,  said, 
among  other  things  :  "  Paul  Gassen's  erector  is  in  gen- 
eral adapted  to  afford  the  results  claimed  for  it  in  the 
circular,  in  spite  of  this  being  too  full  of  self-praise,  in  so 
far  as  it  promotes  the  erection,  and  gives  to  the  penis  at 
least  part  of  the  rigidity  requisite  for  the  inimissio  in 
vaginam."  Further :  "  Conditions  of  absolute  impotence 
are,  however,  rare,  and  are  caused  only  by  severe  verte- 
bral and  nervous  diseases.  In  medical  practice  we  have, 
in  a  vast  majority  of  cases,  to  do  merely  with  relative 
impotence  through  physical  causes  (exhaustion  as  a  con- 
sequence of  excesses  of  individuals  who  have  abused 
the  natural  sexual  pleasures  or  in  consequence  of  onah- 
isrn)  or  psychical  (imaginary  obstacles,  fear  of  failure, 
etc.).  Here  a  considerable  or  virtually  the  full  power 
has  been  preserved,  and  the  erector  may,  in  the  first 
case,  compensate  for  the  failing  remainder  of  power,  and 
afford,  as  it  were,  a  crutch  for  the  lame;  in  the  latter 
case  it  acts,  in  combination  with  its  mechanical  action, 
psychically,  and,  awakening  the  confidence  in  the  re- 
quired capacity,  it  compensates  for  the  imaginary  ob- 
stacles called  forth  by  the  mistrust  of  his  own  power, 
under  circumstances  preventing  erection ;  just  as,  for 
example,  any  one  suffering  from  agoraphobia,  being  in 
this  psychical  anomaly  incapable  of  crossing  a  square,  is 
enabled  to  do  so  when  accompanied  at  starting  merely 
by  a  child. 


TREATMENT.  267 

"  The  inventor  of  the  erector,  in  his  circular,  had  in 
view  as  a  layman  merely  the  mechanical  effect  of  his 
instrument,  and  those  debilitated  and  enervated  through 
sexual  abuse.  He  had  no  idea  that  there  are  very  many 
sufferers  with  impotence  who  are  so  from  no  fault  of 
theirs,  through  psychical  influence,  and  only  requiring 
psychical  aid. 

"  In  so  far,  however,  as  the  instrument  is  adapted,  in 
cases  of  merely  relative  impotence,  to  accomplish  impor- 
tant ends,  at  least  to  facilitate  the  sexual  act  mechani- 
cally, it  gives  a  quasi-guaranty  of  the  result  in  the  case 
of  the  psychically  impotent,  and  frees  him,  through  the 
success  attained,  of  his  psychical  obstacles,  and  thus 
renders  him  absolutely  able.  In  this  respect  we  might 
even  speak  of  a  (psychical)  cure  through  the  erector. 

"  As  the  potentia  creundi  is  a  necessary  condition  for 
the  potentia  procreandi,  the  erector  appears  eventually 
also  adapted  for  insuring  the  latter  capacity. 

"As,  however,  the  instrument  essentially  facilitates 
the  conditions  for  the  accomplishment  of  coitus,  impo- 
tence being  for  the  one  who  suffers  from  it  a  physical 
and  psychical  evil,  its  use,  rendering  possible,  as  it  does, 
the  accomplishment  of  a  function  natural  and  important 
both  for  the  body  and  for  the  soul  (psyche),  can  in  general 
operate  only  favorably,  except  in  case  one  is  misled  by 
the  artificial  contrivance  to  excesses  in  coitus — a  cir- 
cumstance, however,  which  should  not  be  attributed  to 
the  instrument,  but  to  the  wearer. 

"  In  view  of  the  very  great  frequency  of  impotence 
in  modern  society,  and  the  significance  of  this  evil  for 
those  who  suffer  from  it,  as  well  as  the  imperfection 
of  medicinal  and  physical  remedies,  the  fact  is  readily 
understood  that  mechanical  expedients  have  long  ago 


268  SEXUAL  IMPOTEM  I'. 

been  devised  by  physicians  to  conic  lo  Ilic  aid  of  failing 
or  weakened  power."  Furllier:  '•  Tan!  (iassen  lias,  as 
we  see,  scientific  medical  predecessors  in  the  domain  of 
invention  of  mechanical  contrivances  for  the  removal  of 
impotence,  and  the  need  of  such  will  always  exist,  since. 
on  the  one  hand,  the  medicaments  at  our  disposal  are 
only  exceptionally  able  to  cure  impotence,  and,  on  the 
other  hand,  the  most  important  interests  of  patients  are 
at  stake  :  health,  fitness  for  marriage,  capacity  for  pro- 
creation, and,  in  the  negative  case,  bodily  and  mental 
disease,  suicide,  adultery,  etc. 

"Accordingly,  Paul  Gassen's  erector  appears  at  the 
present  time  as  the  best  expedient  for  the  improvement 
and  attainment  of  sexual  capacity  for  all  who  are  in  the 
sad  condition  of  needing  the  service  of  such  mechanical 
contrivances,  and  medical  science  would  have  been 
under  obligation  to  the  inventor  if  he  had  placed  liis 
invention  at  the  disposal  of  its  representatives  for  trial 
and  application,  instead  of  making  it  from  the  start  an 
object  of  advertisement  and  mercantile  enterprise." 

Fiirb ringer  also  thinks  that  Gassen's  erector  must  be 
considered  an  instrument  constructed  on  rational  prin- 
ciples, when  used  under  proper  circumstances.  In  a 
simple  and  ingenious  manner  it  has  completed  the  prin- 
ciple of  the  "  sledge,"  under  the  form  of  an  elastically 
flexible  serpentine  coil  in  such  a  manner  that  opposite 
to  each  point  of  pressure  there  is  a  corresponding  point 
without  such  pressure.  Prevention  of  natural  erection 
in  any  way  is  accordingly  excluded.  Furbringer  joins 
also  in  the  view  of  the  two  medical  experts  who,  to- 
gether with  Krafft-Ebing,  expressed  themselves  in  those 
lawsuits,  that  by  means  of  the  erector,  which,  for  the 
rest  does  not  always  fit  equally  well,  the  erector  may  be 
maintained  after  ejaculation. 


TREATMENT.  269 

My  own  experiences  with  Gassen's  apparatus  are,  with 
respect  to  the  erector,  decidedly  in  harmony  with  the 
views  just  quoted.  The  erector,  when  made  according 
to  correct  measurement,  supports  the  flaccid  member  so 
that  it  can  be  introduced  into  the  vagina.  This  is  par- 
ticularly easy  of  accomplishment  by  partial  or  even  only 
slight  erection,  and  through  the  movements  of  coitus 
thereby  rendered  possible  the  erection  is  augmented  or 
even  completed  in  cases  where  this  is  possible  at  all,  and 
a  gradual  vanishing  of  the  erection,  as  usually  happens 
in  so  many  cases  of  neurasthenic  impotence,  is  pre- 
vented. 

Gassen's  compressors  are  no  new  idea ;  similar  expe- 
dients were  known  to  me  years  ago,  but  his  compressors 
are  preferable  to  the  formerly  used  annular  compressor, 
because  they  are  easily  put  on  and  quickly  removed. 
The  compressors  are  hardly  capable  by  themselves  of 
causing  an  erection,  but  they  can  maintain  and  increase 
an  already  existing  partial  filling  of  the  cavernous  tissue, 
exerting,  as  they  do,  the  necessary  pressure  to  check  the 
reflux  of  the  venous  blood,  but  not  compressing  the 
arteries. 

The  suction-pump  called  by  Gassen  the  "  cumulator" 
can,  in  particular  cases,  be  used  for  a  kind  of  gymnastics 
of  the  erectile  tissue.  It  is  new  in  execution,  but  the 
principle  is  old. 

Considering  the  experience  I  have  had  with  "the 
sledge,"  we  must  assume  that  the  erector  will  bring  aid 
in  many  cases  of  impotence.  Should  any  one  abuse  the 
apparatus  in  practising  excesses,  this  would  be  the  fault, 
as  Fiirbringer  correctly  remarks,  of  the  individual,  and 
not  of  the  apparatus.  When  I  remember  the  case  com- 
municated by  me  at  the  time,  in  which  a  psychically 


270  SKMAI,  I.MM IT i<:.\ a:. 

impotent  young  man  was  able  lo  ;iccoiii|ilisli  copulation 
diily  when  he  had  Hie  so-culled  "  sledire"  as  a  surely 
with  him,  without,  however,  ever  really  making  use  of 
it.  il  is  to  he  expected  Ihal,  iieiirasl henic  impotence  will 
furnish  a  good  held  for  Ihese  mechanical  remedies. 

The  use  of  Gassen's  "ultima'1  will  hardly  ever  he  mi- 
vised  by  any  physician,  though  extreme  ;md  exlraordi- 
nary  cases  may  justify  even  tliis  kind  of  a  lasl.  refuge. 

lu  Ihe  trealmenl,  of  most  forms  of  impotence  special 
weight  must  be  attached  to  Hie  regulation  of  the  sexual 
life.  Here  also  we  must  carefully  consider  the  form  of 
the  disease,  as  well  as  the  constitution  and  general  dis- 
position of  the  patient.  There  may  be  cases  in  which 
the  physician  is  compelled  to  order  absolute  continence, 
in  accordance  with  what  we  have  previously  stated  on 
this  subject.  This  advice  will  generally  he  indicated  only 
in  those  cases  in  which  the  patient  is  to  be  convinced  that 
he  is  in  reality  not  impotent. 

Generally,  however,  the  physician  will  find  it  neces- 
sary to  order  the  patient  to  have  regular  intercourse 
and  this  advice  may  have  to  be  given  sometimes  from 
the  very  beginning,  sometimes  later  in  the  course  of  the 
treatment.  The  medical  man  must  feel  it  incumbent 
upon  himself  to  do  his  duty  conscientiously  and  accord- 
ing to  his  best  knowledge,  even  though  he  may  fail  to 
sustain  his  "  dignity."  The  times  have  gone  by  when 
the  doctor  walked  along  gravely  adorned  with  his  doc- 
torate's hat,  his  stick,  and  his  periwig ;  they  have  gone 
by  together  with  the  periwig  and  the  pigtail.  It  is  well 
that  they  are  passed,  and  it  is  to  be  hoped  that  they  are 
forgotten.  In  our  days  we  wish  to  advise  and  help  the 
sick.  Our  dignity  does  not  suffer  if  we  order  regular 
sexual  indulgence. 


TREATMENT.  271 

I  notice  with  very  much  satisfaction  that  I  am  not 
alone  in  my  ideas  upon  this  subject,  the  expression  of 
which,  about  nine  years  ago,  earned  for  me  so  much 
adverse  criticism.  Prince  A.  Morrow,1  for  instance, 
says,  "  The  exercise  of  the  sexual  organs  within  certain 
bounds  undoubtedly  has  the  effect  of  strengthening,  in- 
vigorating, and  preserving  them  in  their  full  integrity." 

Such  a  prescription  may  be  easily  given,  but  for  its 
compounding  the  patient  cannot  be  referred  to  a  druggist. 
The  physician  is  not  supposed  to  give  himself  trouble 
about  the  procuring  of  a  suitable  companion ;  but  even 
on  this  question  the  doctor  may  not  refuse  advice, 
especially  when  he  is  rendered  competent  by  knowledge 
of  medicine  and  the  world. 

In  these  cases  physicians  have,  in  all  times,  advised  mar- 
rldf/e.  Now,  marriage  is  a  delicate  and  important  affair. 
Still,  I  do  not  entertain  the  views  of  those  authors  who 
will  not  admit  that  matrimony  should  be  advised  from 
the  therapeutic  standpoint.  I  believe  that  matrimony  is 
a  contract  in  which  one  party  agrees  to  give  something 
for  something  to  be  obtained  in  return.  It  is  a  serious 
matter  to  advise  matrimony,  for  no  physician  wrishes  to 
carry  on  his  conscience  the  misfortune  that  may  arise 
from  another  man's  matrimonial  venture.  It  must,  how- 
ever, be  admitted  that  marriage  with  a  suitable  person 
is  the  safest  and  most  reliable  remedy  for  many  forms  of 
impotence,  and  it  serves  also  as  a  great  preventive  against 
the  contraction  of  impotence.  On  the  other  hand,  most 
patients  object  to  matrimony.  Many  even  have  an  aver- 
sion for  marriage  in  general,  and  think  they  have  suffi- 
cient reason  for  their  belief.  In  such  a  case  the  phy- 

1  A  System  of  Genito-Urinary  Diseases,  vol.  i.  p.  1003. 


•_>7-_>  SEXUAL   IMPOTENCE. 

sici;in  will,  of  course,  not  insist  on  his  advice.  Others, 
again,  (Ian-  mil  renture  to  enter  into  matrimony  because 
I  hey  believe  themselves  to  be  unable  to  fulfil  their  con- 
jugal duties.  If  Ihe  physician  finds  this  to  be  true,  there 
is  again  every  reason  for  not  advising  matrimony. 

A  man  who  is  even  moderately  virile  had  belter  be 
dissuaded  from  marriage,  because  his  sexual  weakness 
would  render  his  hymeneal  happiness  doubtful,  unless 
he  should  happen  to  find  a  wife  not  particularly  given  to 
sexual  pleasure.  Here  very  great  discernment  and  cau- 
tion should  prevail,  because  such  a  quality  is  not  to  be 
read  on  the  forehead  or  face  -of  a  woman.  See  here 
the  beautiful  diplomatic  language  with  which  llosenthal1 
expresses  his  opinion:  "In  case  of  recovery  or  lasting 
improvement  in  the  sexual  power,  a  subsequent  marriage 
to  a  person  of  calm  temperament  may  be  allowed  in 
order  to  preserve  the  restored  condition." 

As  marriage  is  a  heroic  and  very  dangerous  remedy 
not  accessible,  to  every  one,  and  as  a  mistake  in  this 
affair  is  so  difficult  to  correct,  many  a  convalescent 
patient  will  be  compelled  to  have  recourse  to  other  con- 
nections than  hymeneal  in  order  to  satisfy  his  sexual 
desire,  if  he  does  not  want  to  become  impotent  again 
or  to  be  troubled  again  by  morbid  pollutions.  He  must 
satisfy  this  natural  want  regularly,  and  the  act  cannot  be 
called  immoral  simply  because  it  is  accomplished  out  of 
wedlock.  Such  connections  may  be  unknown  to  dried- 
up  pedants  who  have  never  been  young,  but  every  man 
gifted  with  a  heart  and  physical  power  is  familiar  with 
these  liaisons  in  all  their  variations. 


1  Ueber  den  Einfluss  von  Nervenkrankheiten  auf  Zeugung  und 
Slerilitat.     Wiener  Klinik,  1880,  Heft  5,  p.  141 . 


TREATMENT.  273 

An  individual  weak  in  sexualibus  is  seldom  lucky 
enough  to  captivate  a  woman's  heart,  and  prostitutes 
are  his  only  recourse.  Modern  prostitution  is,  as  Man- 
tegazza 1  expresses  it,  "  The  product  of  the  Christian 
virtue,  which  wants  a  perfect  man,  and  the  animal  in- 
stinct, which  drives  the  man  into  a  woman's  arms." 

We  must  consider  that  the  functional  capacity  in  in- 
tercourse with  a  prostitute  is  not  in  proportion  to  the  ac- 
tual sexual  power,  and  that  real  prostitutes — i.e.,  those 
"  whom  any  one  can  buy"  2 — are  too  repulsive  to  please 
the  good  taste  of  some  patients.  Again,  we  must  con- 
sider the  dangers  of  venereal  diseases.  Pamphlets 
bearing  the  pompous  title  of  "  Prevention  of  sexual 
contagion"  3  certainly  prevent  nothing  whatever,  and, 
moreover,  tell  only  facts  known  to  every  one  beforehand. 

It  is  obvious  that  a  physician  can  in  these  matters 
give  little  advice  to  his  patient,  but  must  entrust  him  to 
good  luck.  Besides,  when  the  physician  has  done  his 
duty  toward  an  individual  and  cured  him  completely  or 
partially,  he  can  generally  yield  him  to  his  fate  with 
tranquillity,  because  most  of  the  sexually  weak  persons 
who  take  medical  advice  are  of  the  intelligent  and 
wealthy  class  of  society. 

The  sanguine  hopes  that  were  entertained  once  about 
the  result  of  inhalations  of  oxygen  have  proved,  by 
thorough  investigation  and  experiments,  to  be  a  mere 
fata  Morgana.  Sometimes,  however,  this  remedy  may 
be  given  a  trial,  because  it  may  be  beneficial,  and  es- 
pecially in  cases  complicated  with  anemia,  leukemia, 
diabetes,  dyspepsia,  and  chronic  weakness. 

1  Gli  amori  degli  uoinini.     Milano,  1886,  vol.  ii.  p.  201. 

2  Jeannel,  De  la  prostitution.     Paris,  1874,  p.  190. 

3  For  instance,  Dr.  A.  Theod.  Stamm,  Zurich,  1886. 

18 


274  S KXUAL   IMI'OTKM  K. 

The  therapeutics  of  impotence  has  been  greatly  en- 
riched liy  Motschutkovsky.  who,  \vliilsl  applying  Sayre's 
corset,  noticed  that  the  body  lengthened  during  suspen- 
sion. Repeated  measurements  proved  that  this  length- 
ening is  due  to  the  stretching  of  the  vertebral  column, 
and  varies  between  two  and  one-half  and  five  centime- 
ters. This  led  Motschutkovsky  to  the  idea  of  Irving  sus- 
pension in  diseases  of  the  spinal  cord.  The  result  was 
excellent:  several  troublesome  symptoms  vanished  due- 
ing  the  treatment.  Of  chief  interest  for  us  in  this  ex- 
perimentation is  the  circumstance  that  in  every  rase 
a  certain  number  of  suspensions  removed  all  the  pre- 
existing disturbances  in  the  sexual  feelings  and  power. 
In  Charcot's  clinique  at  Paris  the  same  fact  was  estab- 
lished, along  with  decided  improvement  in  functional 
diseases  of  the  bladder,  so  often  accompanying  tabes  ; 
and  also  the  cure  of  neurasthenic  impotence.  Bcrnhard 
reports  a  case  in  which,  after  nineteen  suspensions,  erec- 
tion and  pollutions  reappeared  after  having  been  absent 
for  over  a  year. 

I  have  treated  with  suspension  numerous  patients 
threatened  with  paralytic  impotence,  and  in  several 
cases  obtained  considerable  improvement.  After  a  lew 
suspensions  erections  and  libido  partially  returned.  I 
never  noticed  lasting  results,  however.  Everything  re- 
turned to  the  old  state  a  few  days  after  the  cessation  of 
the  suspensions,  and,  moreover,  the  suspensions  them- 
selves lost  their  efficacy  after  a  few  weeks.  These  sus- 
pensions in  paralytic  impotence  may  be  compared  to  one 
of  the  last  lashes  given  to  a  jaded  beast  of  burden. 

Since,  however,  suspensions  have  had  some  effect  on 
paralytic  impotence,  a  disease  in  which  therapeutics  is 
usually  powerless,  it  was  certainly  to  be  expected  that 


TREATMENT.  275 

they  would  produce  better,  or  even  satisfactory,  results 
in  forms  of  impotence  that  are  easier  to  cure.  Indeed, 
I  have  obtained  very  favorable  results,  and  sometimes  a 
ptTl'rH  cure,  in  various  cases  of  sexual  neurasthenia. 

One  of  these  cases,  which  I  published  at  the  time,  I 
shall  reproduce  here.  B.  K.,  a  lawyer,  thirty-four  years 
old,  somewhat  thin,  though  always  healthy,  had  in  his 
youth  passed  through  his  experiences  with  onanism. 
After  that  he  was  on  intimate  terms  for  six  years  with  a 
woman  two  years  his  senior.  During  this  entire  con- 
ned ion  he  never  experienced  any  signs  of  impotence, 
for  he  was  all  the  time  able  to  accomplish  the  act  to  his 
heart's  content.  In  the  rare  intercourse  he  had  with 
prostitutes  during  those  six  years  he  had  a  few  failures 
in  coition,  but  did  not  attach  any  importance  to  them. 
For  five  weeks  before  he  applied  to  me  he  had  vainly 
endeavored  to  accomplish  coition,  although  his  oppor- 
tunities had  been  most  favorable  and  the  responsiveness 
of  his  companion  all  that  could  be  desired.  Hence  he 
was  in  a  state  of  great  excitement  and  believed  himself 
to  be  quite  and  permanently  impotent.  After  a  fruitless 
attempt  with  nux  vomica  I  proceeded  to  the  use  of  sus- 
pensions, after  having  represented  them  to  be  a  sure 
and  infallible  curative  remedy.  I  was  informed  by  the 
patient  that  he  had  erections  in  the  night  following  the 
first  suspension,  and  after  the  fifth  he  accomplished  coi- 
tion without  my  permission,  and  he  assured  me  he  did 
not  need  further  medical  treatment.  After  the  ninth 
suspension  I  dismissed  him  from  my  care. 

Although  the  result  was  satisfactory  in  this  case  as 
well  as  in  many  others,  I  was  not  convinced  that  these 
suspensions  had  an  aphrodisiac  power,  because  I  knew 
that  psychically  impotent  persons  are  sometimes  cured  by 


276  SEXUAL   IMPOTENCE. 

Hie  most  inefficient  means.  To  tost  the  suspensions  a 
little  further  I  frequently  used  them  on  heullhy  persons. 
Though  imagination  may  have  had  more  or  less  influence 
on  these  persons,  they  asserted  that  the  suspensions  had 
a  stimulating  effect  on  the  sexual  desire. 

I  tried  suspensions  in  a  case  of  frigidity  on  the  part  of 
a  married  lady.  Both  she  and  her  husband  attributed 
the  absence  of  children  to  this  cause,  but  an  exami- 
nation was  refused.  Although  in  this  case  suspensions 
had  no  effect  whatever,  I  do  not  contend  that  they  have 
no  efficacy  in  frigidity,  which  is  not  infrequent  in  women, 
and  I  think  further  experiments  advisable.  In  the  rase 
just  mentioned,  I  believe  the  wife  had  an  aversion  for 
her  husband,  although  she  assured  me  to  the  contrary. 

For  these  suspensions  I  invariably  use  Sayre's  appa- 
ratus modified  by  Motschutkovsky.  The  act  of  suspend- 
ing is  accomplished  gradually  and  with  great  care.  The 
first  suspension  never  lasts  over  two  minutes,  but  in 
most  cases  I  have  to  limit  it  to  one  minute  or  less.  By 
degrees,  as  the  patients  feel  less  afraid,  the  duration  can 
be  prolonged ;  but  I  have  never  gone  beyond  five  min- 
utes, not  even  when  enthusiastic  patients  requested  it. 
Almost  without  exception  they  were  made  every  second 
day. 

As  to  the  manner  in  which  the  suspensions  act,  we 
must  confine  ourselves  more  or  less  to  conjecture.  Is 
the  cause  the  momentary  change  brought  about  in  the 
position  of  the  spinal  cord  and  its  nerve-trunks  ?  Is  it 
the  tension  of  the  more  peripherally  situated  nerves? 
Is  it  the  increased  pressure  of  the  blood  and  the  in- 
creased circulation  of  blood  in  the  vessels  of  the  spinal 
cord,  which  possibly  is  caused  by  the  increased  blood- 
pressure  ? 


TREATMENT.  277 

Of  course,  suspension  is  out  of  the  question  with  per- 
sons suffering  from  defects  of  the  heart,  atheroma,  aneu- 
rism, emphysema,  cavities  in  the  lungs,  inclination  to 
hemorrhage  from  the  lungs,  epilepsy,  apoplexy,  also 
anemia  of  a  high  degree.  Every  physician  should  de- 
vote his  attention  to  these  evils  before  commencing  any 
treatment  for  impotence. 

Finally,  I  wish  to  mention  a  therapeutic  procedure 

that  has  enthusiastic  supporters,  but  also  many  bitter  op- 

.ponents.     I  mean  hypnotism,  the  therapeutic  measure 

by  which  real  miracles  are  sometimes  accomplished,  in 

spite  of  statements  to  the  contrary. 

I  have  personally  obtained  very  good  results  in  several 
cases  that  were  suitable  for  such  treatment;  but  at  the 
same  time  one  should  be  guarded  against  self-delusion. 
In  the  treatment  of  psychical  impotence  suggestion  is, 
indeed,  the  means  without  which  we  can  expect  but 
little  result ;  and  from  suggestion  to  hypnotism  there  is 
only  one  step. 

Bernheim l  was  able  to  influence  menstruation  by 
hypnotic  suggestion.  Krafft-Ebing2  wrote  thus:  "The 
task  of  posthypnotic  suggestion  is  in  such  cases  to  sug- 
gest a  dissuasion  from  the  impulse  to  commit  masturba- 
tion ;  to  create,  by  suggestion,  a  feeling  against  homo- 
sexual desires  ;  to  induce  a  consciousness  of  virility,  and 
to  arouse  heterosexual  desires." 

Baron  v.  Schrenck-Notzing  relates  one  of  his  cases 
that  beautifully  illustrates  the  therapeutic  power  of  sug- 
gestion.3 Another  case  may  be  mentioned,  that  of  Tessie 

1  De  la  suggestion.     Paris,  1888,  pp.  557-563. 

2  Psychopathia  sexualis.     Stuttgart,  1890,  p.  225. 

3  Ueber   Suggestionstherapie   bei   contrarer  Sexualempfmdung. 
Internal,  klin.  Rundschau.     Wien,  1891,  No.  26. 


278  SEXUAL  IMPOTENCE. 

quoted  by  Casper.1  Many  cases  of  neurasthenia  liave 
been  cured  by  bypnotic  suggestion.  Berillon  reports 
more  than  twenty-two  cases  of  nocturnal  incontinence 
of  urine,  and  four  cases  of  irresistible  onanism  in  chil- 
dren.2 

When  all  of  this  is  considered,  we  may  justly  expect 
hypnotic  suggestion  to  prove  to  be  a  powerful  remedy  in 
onanism,  morbid  pollutions,  and  various  forms  of  impo- 
tence. 

In  conclusion,  I  must  speak  of  organotherapy,  which, 
Iliongh.  still  in  its  inceptive  stadium,  promises  great  re- 
sults. My  personal  experience  with  Brown-Sequard's 
liquor  testiculorum  is  best  expressed  in  the  words  that 
Eulenburg3  uses  when  he  speaks  of  his  own  experience 
with  Poehl's  spermine :  viz.,  "The  results  are  varying 
and  unequal,  though  sometimes  surprisingly  favorable 
wilhout  any  disagreeable  collateral  action."  G.  Hirsdi  ' 
is  inclined  to  think  that  Brown-Sequard's  tesliciilar 
emulsion  contains  both  substances,  which  when  ejecled 
are  useful,  and  substances  which  have  a  disturbing  action 
on  the  metabolism.  Professor  Poehl  was  able  to  isolate 
a  substance,  spermin,  which  he  thinks  is  contained  in  all 
organs  used  therapeutically.  Hirsch  has  tried  Poeld's 
spermin  in  cases  of  anemia,  tabes  dorsalis,  and  endar- 
teritis  obliterans,  and  by  his  own  observations  communi- 


1  Casper,  Impotentia  et  Sterilitas  virilis.     Miinchen,  1890,  p.  W. 

2  Berillon,  Ueber  die  Indicationen  fiir  die  hypnotische  Suggestion 
in  der  Psychiatric  und  Neuropathologie.     Vortrag,  gehalten  in  der 
Section  ftir  Neurolgie  und  Psychiatric  des  X.  internal,  med.  Con- 
gresses zn  Berlin.    Ref.  d.  Wiener  med.  Presse,  1891,  No.  3. 

3  Sexuale  Neuropalhie.     Leipzig,  1895,  p.  41. 

.   4  St.    Petersburger    im-.l.    \Vochenschrift,  1897,   No.  7;    British 
Medical  Journal,  1898. 


TREATMENT.  279 

cated  to  him  he  has  arrived  at  the  following  conclusions. 
The  spermin  has  no  specific  action  at  all  in  particular 
diseases.  It  seems,  however,  to  control  in  some  way 
the  metabolism  or  intraorganic  oxidation,  and  by  the 
removal  of  accumulated  waste  products  to  disencumber 
the  nervous  system,  and  so  finally  to  favor  the  vis  medi- 
catrix  naturae. 

On  the  whole,  a  trial  may  be  ventured,  and  further  ex- 
periments are  advisable.  Brown-Sequard's  fluid  of  the 
best  quality  has  always  been  sent  to  me  directly  by  a 
druggist  in  Geneva. 


CHAPTER  X. 
SPECIAL  THERAPEUTICS. 

IN  this  section  I  shall  briefly  discuss  Hie  curative 
methods  as  they  are  indicated  in  the  various  forms  and 
grades  of  impotence. 

The  therapeutics  of  congenital  and  acquired  malfor- 
mations and  defects  in  the  sexual  organs  will  be  indi- 
cated in  each  case  by  an  examination,  and  if  anything 
is  to  be  done  at  all,  some  surgical  operation  will  have  to 
be  performed  in  nearly  all  cases. 

Impotence  that  has  come  in  the  track  of  diU'm-nl 
pathological  conditions  can  be  treated  only  after  removal 
of  these  causal  conditions,  this  being  accomplished  by 
well  known  and  approved  methods.  If  impotence  should 
still  remain  after  the  removal  of  the  causes,  we  must 
then  call  into  service  all  the  stimulating  means  at  our 
disposal,  together  with  a  selected  diet  appropriate  for 
convalescent  patients.  The  means  indicated  then  are, 
first,  hydro-therapeutic  measures,  electricity,  river- 
bathing  or  sea-bathing,  and  eventually  the  internal  use 
of  nux  vomica  and  oxygen-inhalations. 

The  treatment  of  inherited  sexual  weakness  is  very 
difficult.  First  of  all  the  sexual  desire  must  be 
awakened.  This  cannot  be  the  business  of  the  medical 
practitioner,  but  must  be  left  to  friends  or  relatives 
of  the  patient,  who  may  be  advised  by  the  physician. 
After  the  sexual  desire  has  once  been  a\vakened,  we 

280 


SPECIAL  THERAPEUTICS.  281 

may  proceed  to  the  use  of  various  means  of  stimulation 
in  order  to  arouse  the  sexual  power  that  possibly  lies 
dormant ;  but  experience  teaches  that  this  is  hardly 
ever  successful.  Fortunately,  sexual  weakness  of  a  high 
degree  is  seldom  inherited. 

The  medical  science  is  of  but  little  use  in  the  cure 
of  perverse  sexual  sensation.  However,  education,  or 
perhaps  hypnotic  suggestion,  may  be  of  some  benefit. 

When  sexual  neurasthenia  and  impotence  have  been 
induced  by  bad  management  of  the  sexual  power,  thera- 
peutics must  choose  various  means  in  accordance  with 
the  state  and  physical  strength  of  the  patient.  In  every 
case  the  treatment  must  begin  with  the  regulation  of 
the  sexual  life,  and  in  some  isolated  cases  it  may  be  ad- 
visable to  order  continence  of  moderate  duration.  It 
will  be  proper  to  order  for  individuals  in  a  declining 
condition,  besides  a  correct  diet  and  certain  medica- 
ments, gymnastics,  massage,  hydro-therapeutics,  oxygen- 
inhalation,  or  general  electrization  of  the  body.  In 
patients  who  are  still  physically  strong  you  will  find  in- 
dicated, besides  ordinary  food,  which  need  not  be  too 
delicate,  hydro-therapeutics,  local  electricity,  the  sound 
or  bougie  treatment,  local  injections,  cauterization  of  the 
caput  gallinaginis,  and,  possibly,  suspensions. 

As  above  mentioned,  in  case  onanism  or  spermator- 
rhea  exists,  we  must  endeavor  energetically  to  correct 
them. 

In  the  case  of  impotence  originating  from  continence, 
which,  however,  is  exceedingly  rare,  it  is  the  physician's 
duty  to  reawaken  the  dormant  virile  power ;  that  is,  he 
must  stimulate  vigorously  the  sexual  nerve-centers  and 
tracts  that  have  grown  indolent  from  want  of  proper  ex- 
citation. In  this  case,  bad  company,  which  has  the  repu- 


282  SEXUAL  IMPOTENCE. 

tation  of  spoiling  good  manners,  may  do  some  good.  If 
necessary,  recourse  may  ])••  li;id  lo  electricity,  douches, 
suspensions,  and  local  stimulation  of  the  mucous  mem- 
brane of  the  urethra,  especially  of  the  caput  gallinaginis. 

Most  of  all,  purely  neurasthenic  impotence  presents 
numerous  difficulties,  because  an  unwise  treatment  may 
easily  do  harm.  On  the  other  hand,  a  physician  Avho 
kiniws  how  to  think  will  find  this  a  most  satisfactory 
field  for  his  action,  because  good  results  are  here  more 
easily  obtained  than  in  any  other  form  of  impotence.  A 
wise,  psychical  treatment  does  much  in  such  cases,  but 
cannot  constitute  the  entire  treatment.  Neurasthenic 
conditions  cannot  be  cured  by  simply  telling  the  patient 
that  he  is  not  afflicted.  Often  hypnotic  suggestion  does 
very  good  service. 

In  so-called  irritable  weakness  we  may  exercise  some 
good  influence  against  precipitate  ejaculation  by  toning 
up  the  body  in  general  and  the  sexual  power  in  par- 
ticular. The  means  suitable  for  that  effect  are  hydro- 
therapeutics,  sea-bathing,  river-bathing,  gymnastics,  mas- 
sage, and  the  psychrophor  and  the  sound  to  lessen  the 
sensibility  of  the  mucous  membrane  of  the  urethra. 
Every  exciting  means  must  be  avoided  in  case  the  irri- 
table weakness  is  attended  by  sexual  agitation  in  a  high 
degree. 

Edward  Martin1  recommends  for  the  avoidance  of  pre- 
mature ejaculation,  "  where  the  patient  is  educated  and 
has  a  trained  mind,  the  concentration  of  the  latter  upon 
some  act  of  memory,  such  as  recalling  a  recitation,  or 
upon  some  calculation  in  mathematics."  I  am  afraid 


1  Impotence  and  Sterility.    Hare  :  System  of  Practical  Therapeu- 
tics.    Philadelphia,  1892,  vol.  iii.  p.  665. 


SPECIAL  THERAPEUTICS.  283 

that  such  a  scheme  would  work  in  but  very  few  cases, 
because  we  know  quite  well  that  anything  which  dis- 
tracts the  mind  from  the  sexual  act  is  apt  to  impair  the 
necessary  erection. 

I  have  found  that  one  or  two  glasses  of  good  beer 
taken  before  the  act  very  often  controls  precipitate  ejac- 
ulation. 

In  other  forms  of  sexual  neurasthenia  the  treatment 
will  be  determined  in  each  case  by  such  causes  as  can 
be  discovered,  and  the  case  may  have  to  be  treated 
symptomatic-ally.  In  all  cases  the  frequency  of  inter- 
course must  be  regulated. 

Impotence  induced  by  occupation  may  also  be  a  sub- 
ject for  treatment,  but  good  results  can  then  be  obtained 
only  when  one  succeeds  in  annihilating,  or  at  least  dimin- 
ishing, the  injurious  influences  of  the  occupation. 

Senile  impotence  can  never  be  the  subject  of  rational 
medical  treatment,  though  one  may  sometimes  sympa- 
tliixe  with  an  amorous  old  man. 


INDEX. 


ABLUTIONS,  246. 

Absence  of  the  penis,  87. 

Acupuncture,  261. 

Acute  diseases  and  sexual  vigor, 
97. 

Age  in  etiology  of  impotence,  81. 

Albuginea  of  the  corpora  caver- 
nosa,  43. 

Alcohol,   influence    on    virility, 
113. 

Ampulla  of  Henle,  35. 

Anaesthesia  sexualis,  126. 

Anatomy  of  male  genitals,  30. 

Anemia  and  impotence,  100. 
from  onanism,  171. 

Animals,  perverse  sexual  feeling 
for,  133. 

Antipyrin,  effect  on  virility,  121. 
in  sperrnatorrhea,  234. 

Aphrodisiac  foods,  237. 

Apparatus    for    impotent    men, 
264. 

Arsenic,  effect  on  virility,  119. 

Artists,  sexual  power  in,  203. 

Astringent  injections,  258. 

Atrophy  of  testicles  from  onan- 
ism, 174. 
from  sexual  excess,  159. 

Atropin  in  spermatorrhea,  234. 

Azperger's  rectal-cooling  sound, 
'250. 

BALNEOLOGICAL  treatment,  249. 
Bathing,  in  spermatorrhea,  236. 
Baths,  244. 
Beer,  effect  on  virility,  114. 


Belladonna,   effect    on  "virility, 

12J. 
Bladder  disease  and  virility,  110. 

rheophore,  252. 
Bodily  structure   in  etiology  of 

impotence,  80. 

Body,  effect  of  impotence  on,  25. 
Bougies,  260. 

Brain  disease  and  virility,  102. 
Brornids  in  spermatorrhea,  234. 
Brucin,  241. 

CAMPHOR,  effect  on  virility,  121. 
in  spermatorrhea,  234. 

Cancer  of  the  testicles  and  vi- 
rility, 112. 

Cannabis    indica,   effect  on   vi- 
rility, 118. 

Cantharides,  239. 

Cantharidin,  239. 

Capon-obesity,  21. 

Caput  gallinaginis,  39. 
cauterization  of,  255. 

Carbon-douche,  250. 

Castoreum,  242. 

Cauterization,  254. 

Cavernous   portion  of  the  ure- 
thra, 41. 

Character,    effect   of   impotence 
on,  22. 

Chlorosis  and  impotence,  100. 

Chronic     diseases    and     sexual 
power,  99. 

Cocain   in   treatment  of   impo- 
tence, 243. 

Coffee,  effect  on  virility,  116. 
285 


•JXI5 


INDEX. 


Coition.  ariel-elleHs  of.  1  Iv 
during  menstruation,  221. 
excess  in.  111. 

I'reipiency   (if.    111.   219. 

frequent,  effect  on  semen.  72. 

immoderate,   consequences  Of, 

152. 

physiology  i)t',  45. 
position  in,  220. 
process  of,  56. 
time  for,  220. 
Coitus.     See  Coition. 

iiilt'iTiiptus.  69. 
Cold  and  impotence,  100. 
upplicationsin  spermatorrhea, 

236. 
Colliculus  seminalis,  39. 

diseases  of,  and  virility,  111. 
Congenital  impotence,  122. 
diagnosis  of,  211. 
prognosis  of,  214. 
special  therapeutics  of,  280. 
malformations  and  defects  of 

the  sexual  organs,  87. 
Consecutive  impotence,  97. 
diagnosis  of,  211. 
special  therapeutics  of,  2X0. 
Constipation  as  a  cause  of  pollu- 
tions, 180. 
Continence,  excessive,  eflect  of, 

188. 

Copulation.     See  Coition. 
Cornutinuin   citricum   in    sper- 

matorrhea,  235. 
Corpora  cavernosa,  42. 

changes  in,  96. 
Corpses,  defilement  of,  135. 
Corpus  Highmori,  33. 
Cowper's  glands,  41. 

secretion  of,  and  semen,  68. 
Crista  urethralis,  39. 
Cryptorchidia,  92. 
Cumulator,  269. 

DAMIANA,  244. 

Dartos,  31. 

I )ea Hi  from  sexual  excess,  159. 

Diabetes  and  virility,  99. 

Diagnosis  of  impotence,  209. 


Diet  in  treatment  of  impotence, 

2:;7. 

Digitalis,  ell'ecl  on  virility.  1  17. 
I  liphlherilis  ami  impotence.  '.IS. 
llonche-l.allis.  247. 
Dry  cold,  2.",n. 

warmth.  2->'i. 
Diiclns  ejacnlalorins,  36. 

EJACULATION,  59. 
center  for,  60. 

precipitate,  1!I2. 

premature,  treatment   of.  2*2. 

K.jacnlatory  ducts,  38. 

Electricity     in     spermalorrliea, 
234. 

Electropunclnre.  2<>1. 

Electrotherapeutics.  2">1 . 

Endoscope,  nrelhral.  2">7. 

Endoscopic  examination,  impor- 
tance of,  209. 
in  pollutions.  1X4. 

Epicures,  sexual  power  in,  20-}. 

Epididymis.  -°>4. 

Kpispadia.  ill. 

Erectile  tissue,  defective  devel- 
opment of,  89. 

Erection,  physiology  of,  51. 

Erector.  2<i~>. 

Ergotin,  242. 

Etiology  of  impotence,  79. 

Excess  in  venery,  137. 

Exercises  in  treatment  of  impo- 
tence, 2ti2. 

External  applications.  2<>1. 

FARADIC  current,  253. 

Flagellations,  263. 

Flapping,  246. 

Flogging  and  onanism.  Kill. 

Food  in  treatment  of  impotence, 

237. 
Foods  and  virility,  117. 

stimulating,     and      onanism, 

170. 

Forms  of  impotence,  87. 
Fowler's  solution  in  spermatoi- 

rhea,  234. 
Franklinization,  254. 


INDEX. 


287 


Frauding.  69,  222. 
Frenuluin,  nial formation  of,  90. 
Friction,  24(5. 
Frigidity,  126. 

from  onanisin,  173. 

from  sexual  excess,  153. 

GALVANIC  current,  252. 

General  diseases  as  a  cause  of 

pollutions,  181. 
Genitals,  acquired  defects  of,  93. 

appearance  of,  79. 

congenital  malformations  and 

defects  of,  87. 
Glands  of  Littre,  41. 
Gonorrhea  and  virility,  109. 
Gymnastics,  262. 

in  spermatorrhea,  233. 

sexual,  14(5. 

HAI,F-IUTHS,  248. 

Heredity  in  etiology  of  impo- 
tence, 81. 

Hermaphrodites,  93. 

Hydatis  Morgagni,  34. 

Hydrocele  and  impotence,  95. 

Hydro-electric  baths,  254. 

Hydrotherapeutics  in  sperma- 
torrhea. 232. 

Hydrolherapy.  244. 

Hvirii'iiic  living  in  treatment  of 
impotence,  236. 

Hyperesthesia  of  sexual  organs 
from  onanism,  173. 

Hyperesthesis  of  sexual  sensa- 
tion, 130. 

Hypnotism,  277. 

Hypochondriac,  impotence,  195. 

Hypospadia,  91. 

IDIOCY,  impotence  in,  135. 
Idleness  and  onanism,  170. 
Impotence  and  matrimony,  22. 
classification  of  varieties   of, 

84. 

congenital,  122. 
diagnosis,  211. 
prognosis  of,  214. 
special  therapeutics  of,  280. 


Impotence,  consecutive,  97. 
diagnosis  of,  211. 
special  therapeutics  of,  280. 
definition  of,  28. 
diagnosis  of,  209. 
effect  on  the  body,  25. 
effect  on  character,  22. 
effect  on  the  mind,  20. 
etiology  of,  79. 
forms  of,  87. 
frequency  of,  26. 
from  acquired  defects  of  the 

genitals,  93. 

from  congenital  malforma- 
tions of  the  genitals, 
87. 

hypochondriac,  195. 
inherited     predisposition    to, 

122. 

misfortune  of,  20. 
neurasthenic,  136. 
diagnosis  of,  211. 
prognosis  of,  214. 
special  therapeutics  of,  282. 
paralytic,  156. 
professional,  202. 
prognosis  of,  214. 
prophylaxis  of,  217. 
psychical,  195. 
diagnosis  of,  213. 
treatment  of,  228. 
relative,  199. 
senile,  205. 
temporary,  198. 
treatment  of,  226. 
Impotent   man,   appearance   of, 

21. 
Incontinence  of  urine  and  sexual 

weakness,  124. 
Indian    hemp   in    treatment    of 

impotence,  242. 
Inguinal  hernia  and  impotence, 

95. 

Inhalations  of  oxygen,  273. 
Inherited  predisposition  to  im- 
potence, 122. 
Injections,  astringent,  258. 

urethral,  250. 
Insanity  and  impotence,  102. 


288 


I.NDKX. 


Instruments    Cor    Hit-   impotent, 

264. 

Inlravesiral  irrigations,  259. 
lodin.  effect  on  virility,  120. 
Iron.  -24-2. 
Irritable  weakness,  192. 

special  therapeutics  of,  282. 
Isthmus  nrelhne,  40. 

KRAFFT-EBINC'S  classification  of 
impotence,  84. 

I.ACI  \.i:  Morgagni,  41. 
Lead-poisoning  and  virility,  120. 
Libido  sexualis,  47. 
Liquor  testiculorum,  278. 
Littre's  glands,  41. 
Loral  treatment.  254. 
Love-potions,  239. 
Lupulin.  effect  on  virility,  121. 
Lust-murder,  130. 

MALE  genitalia,  anatomy  of,  30. 
Marriage  in  treatment  of  impo- 
tence, 271. 
Massage,  262. 

Masturbation.     See  Onanism. 
causes  of,  164. 
excessive,  160. 

Medicaments  and  virility,  113. 
in    treatment    of    impotence, 

L':;(.I. 
Menstruation,     coition     dnriiiLr, 

221. 

Menthol,  effect  on  virility,  122. 
Mercury,  effect  on  virility,  120. 
Metal  sounds,  260. 
Mind,    influence    of    impotence 

on,  20. 
Mineral   waters    in    spermalor- 

rhea,  233. 
Monohro mated   camphor,  effect 

on  virility,  121. 
in  spennatorrhea,  234. 
Monorchidia,  !>± 
Morphin,     effect     on     virility, 

118. 

Mnsrnliis  rremasler,  31. 
Musk,  242. 


NARCOTICS  in  impotence.  iM± 
Narrowness  of  the  orilirinm  ex- 

ternnm  urethra-.  Ml. 
Nerve-disease    and    ini]Milence, 

101. 

Nervousness  and  virility,  127. 
Neurasthenia     and      impotence. 

186. 

and  virility,  103. 
from  onanisni.  172. 
from  sexual  exres.-.  I"'.". 
Xelirasllienir  impotence,  1 .'!(). 
diagnosis  of.  211. 
prognosis  of,  214. 
special  therapeutics  of,  282. 
Xiter.  effect  on  virility.  121. 
Xif/e's  endoscope.  2~>7. 

Nux  vomica,  241. 


OBESITY  and  virile  power,  99. 
Obstipation  as  a  cause  of  pollu- 
tions, 180. 
Old     aire.      sexual     power      in, 

205. 
Onanism,  causes  of.  164. 

consequences  of,  171. 

cutaneous  diseases  and,  170. 

excessive,  160. 

flogging  and,  169. 

idleness  and,  170. 

lascivious    reading    and    pic- 
tures and,  Kill. 

prophylaxis  of,  218. 

riding  and,  170. 

sedentary  life  and.  1(1!). 

seduction  and.  Hit!. 

sewing-machines  and,  171. 

stimulating  foods  and,  170. 

tight,  garments  and.  171. 

uncleanlinesa  and.  170. 

unwise  parents  and,  166. 

why     it     causes     pollutions. 

181. 
Opium,  242. 

effect  on  virility,  118. 
Organotherapy.  27S. 
( >rgasm,  sexual.  47. 
Oxygen,  inhalations  of,  27-">. 


INDEX. 


289 


PARALYTIC  impotence,  156. 
Pars  membranacea  urethrae,  40. 

prostatica,  39. 
Pederasty,  132. 

Pendulous  abdomen  and  impo- 
tence, 100. 

Penis,  absence  of,  87. 
curvature  of,  89. 
excessive  development  of,  88. 
flabbiness  of,  89. 
loss  of,  93. 
smallness  of,  88. 
Penis-bones,  97. 
Perverse  sexual  feeling,  128. 
for  animals,  133. 
for  inanimate  objects,  134. 
for  the  other  sex,  130. 
for  persons  of  the  same 

sex,  132. 

Phenol,  effect  on  virility,  122. 
Philters,  239. 
Phimosis,  90. 
Phosphorus,  240. 
Phthisis  and  sexual  vigor,  98. 
Physiology   of   the   sexual  act, 

45. 

Poehl's  spermin,  278. 
Poisons  and  virility,  113. 
Pollutions,  174. 
during  sleep,  176. 
in  the  waking  state,  177. 
morbid  appearance  of  genitals 

in,  185. 

diagnosis  of,  183. 
state  of  health  in,  185. 
treatment  of,  230. 
Precipitate  ejaculations,  192. 
Premature     ejaculation,     treat- 
ment of,  282. 
Prepuce,  absence  of,  89. 

superfluity  of,  90. 
Professional  impotence,  202. 
Prognosis  of  impotence,  214. 
Prophylaxis  of  impotence,  217. 
Prostate,  37. 
Prostatic    disease    and   virility, 

109. 
secretion,  38. 

and  the  semen,  67. 


Prostitutes  in  treatment  of  im- 
potence, 273. 
Psychical  impotence,  195. 

diagnosis  of,  213. 
treatment  of  impotence,  228. 
Psychrophor,  249. 
Puberty,  45. 

QUIMN,  242. 
effect  on  virility,  122. 

RAIN-BATHS,  247. 
Relative  impotence,  199. 
Resorption  of  semen,  63. 
Rest  in  treatment  of  impotence, 

239. 

Rete  vasculosum  testis,  33. 
Rheophore,  bladder,  252. 
Riding  and  onanism,  170. 

effect  on  sexual  power,  205. 
River-bathing,  248. 
Rubbing  down,  246. 

SALICYLIC  acid,  effect  on  virility, 

120. 
Satiety    for    sexual    pleasures, 

154. 

Scholars,  sexual  power  in,  203. 
Scincus  marinus,  243. 
Scrotum,  30. 
Sea-bathing,  248. 

in  spermatorrhea,  233. 
Seasons,    influence    on    sexual 

power,  83. 
Secale  cornutum,  242. 

in  spermatorrhea,  234. 
Sedentary    life    and     onanism, 

169. 

Seduction  and  onanism,  166. 
Semen,  61. 

appearance  of,  70. 
chemical  analysis  of,  70. 
effect  of  frequent  coition  on, 

72. 

constitution  of,  66. 
effect  of  loss  of,  150. 
production  of,  61. 
quantity  ejaculated,  69. 
resorption  of,  63. 


19 


290 


INDEX. 


Seminal  corpuscles,  62. 

vesicles,  35. 
Senile  impotence,  205. 
Septum  scroti,  32. 
Sexual  act,  physiology  of,  •!•">. 
capacity,  50. 
excess,  137. 
atrophy  of   testicles    from, 

159. 

consequences  of,  152. 
death  from,  159. 
reasons  for,  143. 
excitement,  cause  of,  48. 
function,  importance  of,  19. 
gymnastics,  146. 
instinct,  seat  of,  50. 
life,  regulation  of,  270. 
maturity,  45. 
organs,   acquired    defects   of, 

93. 
congenital      malformations 

of,  87. 

disease  of,  and  virility,  108. 
orgasm,  47. 
taste,  changes  in,  154. 
virility,  definition  of,  28. 
Sinapisms,  261. 
Sinus  Morgagni,'40. 

prostaticus,  40. 
Sitz-baths,  247. 
Skopti,  93. 
Sledge,  265. 

Smallness  of  the  penis,  88. 
Smoking,     effect     on     virility, 

116. 
Snuff-taking,  effect  on   virility, 

117. 
Sodium  nitrate,  effect  on  virility, 

121. 

in  spermatorrhea,  234. 
Sodomy,  133. 
Spermatic  canals,  33. 
Spermatoblasts,  61. 
Spermatorrhea,  174. 
treatment  of,  230. 
Spermatozoa,     movements     of, 

78. 

structure  of,  62. 
vitality  of,  71. 


Spermin.  278. 

Spiiiiil-cunl  disease  and  virility. 
102. 

Sponge-bath,  247. 

Siiitic  electricity.  2f>4. 

Stimulants  in  treatment  of  im- 
potence. 24.">. 

Strictures  of  the  urethra  and  vi- 
rility, 111. 

Suppositories,  urelhral,  259. 

Surgical  operations.  261. 

Suspension.  274. 

Swedish  movements,  262. 

TABES  dorsalis   and   impotence, 

101. 

Tea,  effect  on  virility,  116. 
Temporary  impotence,  198. 
Testicle,  absence  of  one,  95. 
Testicles,  absence  of,  94. 
anatomy  of,  30. 
atrophy    of,    from    onanism, 

174. 

cancer  of,  and  virility,  112. 
loss  of,  93. 
tuberculosis   of,  and   virility, 

112. 

undescended.  92. 
Tincture  of  veratrum  viride  in 

spermatorrhea.  234. 
Tobacco,  effect  on  virility,  116. 
Travelling  in  treatment  of  im- 
potence, 262. 
Treatment,  226. 
local.  254. 
psychical,  228. 
Tuberculosis  of  the  testicles  and 

virility,  112. 
Tunica  albuginea,  33. 
dartos,  31. 

vaginalis  communis,  31. 
propria,  31. 

UNCLEANLINESS  and  onanism,  170. 

Urethra,  38. 

Urethral  endoscope,  257. 

injections,  250. 

strictures  and  virility,  111. 

suppositories,  259. 


INDEX. 


291 


Urine,  incontinence  of,  and  sex- 
ual weakness,  124. 
timings,  132. 
Utriculus  prostaticus,  40. 


y.U.F.UIAN,   243. 

Vapor-baths,  248. 
Varicocele       and 

113. 
Vas  deferens,  35. 

epididymis,  34. 
Vasa  aberrantia,  34. 

seminalia,  33. 


impotence, 


Venery,     excessive     impotence 

from,  137. 
Ventouse,  264. 
Verumontanum,  39. 
Vesicula  prostatica,  40. 
Virility,  conditions  influencing, 

79. 

definition  of,  28. 
importance  of,  19. 

WINE,  effect  on  virility,  115. 
Winternitz's       rectal       cooling 

pouch,  250. 
Work  and  sexual  power,  203. 


END. 


Medical  and  Surgical  Works 


.    PUBLISHED   BY 


W.  B.  SAUNDERS,  925  Walnut  Street,  Philadelphia,  Pa. 


Abbott  on  Transmissible  Diseases   ....  40 
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*American  Text-Book  of   Applied   Thera- 
peutics     6 

*American  Text-Book  of  Chemistry  ...  40 
*American  Text-Book  of  Diagnosis  ...  40 
*American  Text- Book  of  Dis.  of  Children  .  n 
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*American  Text-Book  of  Gynecology  .  .  .10 
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Brockway's  Physics 39 

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Jackson's  Diseases  of  the  Eye 40 

Jackson  and  Gleason's  Diseases  of  the  Eye, 

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Venereal  Diseases 39 

Meigs'  Feeding  in  Early  Infancy 26 

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Morris'  Materia  Medica  and  Therapeutics  39 

Morris'  Practice  of  Medicine 39 

Morten's  Nurses'  Dictionary 34 

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Pye's  Bandaging  and  Surgical  Dressing    .  19 

Raymond's  Physiology 37 

Rowland's  Clinical  Skiagraphy 29 

Saundby's  Renal  and  Urinary  Diseases  .    .  21 
*Saunders'  American  Year-Book  of  Medi- 
cine and  Surgery 14 

Saunders'  Medical  Hand-Atlases  .  .  .  .  3,  4 
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on  56  plates,  and  193  beautiful  half-tone  illustrations.     Cloth,  $3.50  net. 
"  Hotmanri's  'Atlas  of  Legal  Medicine'  is  a  unique  work.    This  immense  fielu  finds  in  this 

book  a  pictorial  presentation  that  far  excels  anything  with  which  we  are  familiar  in  any  other 

work ." — Philadelphia.  Medical  Journal. 

Atlas  of  Diseases  of  the  Larynx.  By  DR.  L.  GRUNWAI.U,  of  Munich. 
Eklited  by  CHARLES  P.  C-KAYSON,  M.  D.,  Physician-in-Charge,  Throat  and 
Nose  Department,  Hospital  of  the  University  of  Pennsylvania.  With  107 
colored  figures  on  44  plates,  25  text-illustrations,  and  103  pages  of  text. 
Cloth,  $2.50  net. 

"Aided  as  it  is  by  magnificently  executed  illustrations  in  color,  it  cannot  fail  of  being  of 
the  greatest  advantage  to  students,  general  practitioners,  and  expert  laryngologists." — St. 
Louis  Medical  and  Surgical  Journal. 

Atlas  of  Operative  Surgery.  By  DR.  O.  ZUCKKRKANDL,  of  Vienna.  Edited 
by  J.  CHALMKRS  D.\COSTA,  M.  D.,  Clinical  Professor  of  Surgery,  Jefferson 
Medical  College,  Philadelphia.  With  24  colored  plates,  217  text-illus- 
trations, and  395  pages  of  text.  Cloth,  $3.00  net. 

"  We  know  of  no  other  work  that  combines  such  a  wealth  of  beautiful  illustrations  with 
clearness  and  conciseness  of  language,  that  is  so  entirely  abreast  of  the  latest  achievements, 
and  so  useful  both  for  the  beginner  and  for  one  who  wishes  to  increase  his  knowledge  of  oper- 
ative surgery." — Miincliener  medicinische  Wochi-nsckrift. 

Atlas  of  Syphilis  and  the  Venereal  Diseases.     By  PRO:  .  DR.  FRANZ 
MKACEK,  of  Vienna.     Edited  by  L.  BOLTON   M\x<;>,  M.  I).,  Prof. 
Genito-Urinary  Surgery,  University  and  Bellevue  Hospital  Medical  College, 
New  York.     With  71   colored  plates  from  original  water-colors,  1 6  black- 
and-white  illustrations,  and  122  pages  of  text.     Cloth,  $3.50  net. 

"A  glance  through  the  book  is  almost  like  actual  attendance  upon  a  famous  clinic. "~ 
Journal  of  the  American  Medical  Association. 

Atlas  of  External  Diseases  of  the  Eye.     By  DR.  O.  II \\\\,  of  Zurich. 

Edited  by  G.  E.  DE  SCHWEINIT/.,  M.D.,  Professor  of  Ophthalmology. 
Jefferson  Medical  College,  Philadelphia  With  76  colored  illustrations  on 
40  plates,  and  228  pages  of  text.  Cloth,  $3.00  net. 

Atlas  of  Skin  Diseases.  By  PROF.  DR.  FRAN/.  MKACEK,  of  Vienna. 
Edited  by  HENRY  W.  STEI.WAGON,  M.  D.,  Clinical  Professor  of  Derma- 
tology, Jefferson  Medical  College,  Philadelphia.  With  63  colored  plates, 
39  beautiful  half-tone  illustrations,  and  200  pages  of  text.  Cloth,  $3.50  net. 

IN  PREPARATION. 

Atlas  of  Pathological  Histology.  Atlas  of  Operative  Qynecology. 

Atlas  of  Orthopedic  Surgery.  Atlas  of  Psychiatry. 

Atlas  of  General  Surgery.  Atlas  of  Diseases  of  the  Ear. 


CATALOGUE    OF  MEDICAL    WORKS.  5 

*AN  AMERICAN  TEXT-BOOK  OF  PHYSIOLOGY.  Edited  by 
WILLIAM  H.  HOWELL,  PH.D.,  M.  D.,  Professor  of  Physiology  in  the 
Johns  Hopkins  University,  Baltimore,  Md.  One  handsome  octavo  volume 
of  1052  pages,  fully  illustrated.  Prices:  Cloth,  $6.00  net;  Sheep  or  Half- 
Morocco,  $7.00  net. 

This  work  is  the  most  notable  attempt  yet  made  in  America  to  combine  In 
one  volume  the  entire  subject  of  Human  Physiology  by  well-known  teachers 
who  have  given  especial  study  to  that  part  of  the  subject  upon  which  they  write. 
The  completed  work  represents  the  present  status  of  the  science  of  Physiology, 
particularly  from  the  standpoint  of  the  student  of  medicine  and  of  the  medical 
practitioner. 

The  collaboration  of  several  teachers  in  the  preparation  of  an  elementary  text- 
book of  physiology  is  unusual,  the  almost  invariable  rule  heretofore  having  been 
for  a  single  author  to  write  the  entire  book.  One  of  the  advantages  to  be  derived 
from  this  collaboration  method  is  that  the  more  limited  literature  necessary  for 
consultation  by  each  author  has  enabled  him  to  base  his  elementary  account 
upon  a  comprehensive  knowledge  of  the  subject  assigned  to  him ;  another,  and 
perhaps  the  most  important,  advantage  is  that  the  student  gains  the  point  of  view 
of  a  number  of  teachers.  In  a  measure  he  reaps  the  same  benefit  as  would  be 
obtained  by  following  courses  of  instruction  under  different  teachers.  The 
different  standpoints  assumed,  and  the  differences  in  emphasis  laid  upon  the 
various  lines  of  procedure,  chemical,  physical,  and  anatomical,  should  give  the 
student  a  better  insight  into  the  methods  of  the  science  as  it  exists  to-day.  The 
work  will  also  be  found  useful  to  many  medical  practitioners  who  may  wish  to 
keep  in  touch  with  the  development  of  modern  physiology. 

COXTRIBITTORS : 

HENRY  P.  BOWDITCH,  M.  D.,  WARREN  P.  LOMBARD,  M.D., 

Professor  of  Physiology,  Harvard  Medi-  Professor  of  Physiology,  University  of 

cal  School.  Michigan. 

JOHN  G.  CURTIS,  M.  D., 


Professor  of  Physiology,  Columbia  Uni- 
versity, N.  Y.  (College  of  Physicians 
and  Surgeons). 

HENRY  H.  DONALDSON,  Ph.  D., 

Head- Professor  of  Neurology,  Univer- 
sity of  Chicago. 


GRAHAM  LUSK,  Ph.D., 

Professor  of  Physiology,   Yale   Medic*.' 
School. 

W.  T.  PORTER,  M.D., 

Assistant  Professor  of  Physiology,  Har- 
vard Medical  School. 


W.  H.  HOWELL,  Ph.  D.,  M.  D.,  EDWARD  T.  REICHERT    M.D., 

Professor  of  Physiology,  Johns  Hopkins  Professor  of  Physiology,  University  of 


University. 
FREDERIC  S.  LEE,  Ph.  D., 

Adjunct  Professor  of  Physiology,  Colum- 
bia University,  N.  Y.  (College  of 
Physicians  and  Surgeons). 


Pennsylvania. 

HENRY  SEW  ALL,  Ph.D.,  M.  D., 

Professor  of  Physiology,  Medical  Depart 
ment,  University  of  Denver. 

"  We  can  commend  it  most  heartily,  not  only  to  all  students  of  physiology,  but  to  every 
physician  and  pathologist,  as  a  valuable  and  comprehensive  work  of  reference,  written  by 
men  who  are  of  eminent  authority  in  their  own  special  subjects."  —  London  Lancet, 

"To  the  practitioner  of  medicine  and  to  the  advanced  student  this  volume  constitutes, 
we  believe,  the  best  exposition  of  the  present  status  of  the  science  of  physiology  in  the  Eng- 
lish language." — American  Journal  of  the  Medical  Sciences. 


W.   B.   SAUNDERS 


*AN  AMERICAN  TEXT-BOOK  OF  APPLIED  THERAPEU- 
TICS. For  the  Use  of  Practitioners  and  Students.  Edited  by 
JAMES  C.  WILSON,  M.  D.,  Professor  of  the  Practice  of  Medicine  and  of 
Clinical  Medicine  in  the  Jefferson  Medical  College.  One  handsome  octavo 
volume  of  1326  pages.  Illustrated.  Prices:  Cloth,  $7.00  net;  Sheep  or 
Half- Morocco,  #8.00  net. 

The  arrangement  of  this  volume  has  been  based,  so  far  as  possible,  upon 
modern  pathologic  doctrines,  beginning  with  the  intoxications,  and  following 
with  infections,  diseases  due  to  internal  parasites,  diseases  of  undetermined 
origin,  and  finally  the  disorders  of  the  several  bodily  systems — digestive,  re- 
spiratory, circulatory,  renal,  nervous,  and  cutaneous.  It  was  thought  proper  to 
include  also  a  consideration  of  the  disorders  of  pregnancy. 

The  articles,  with  two  exceptions,  are  the  contributions  of  American  writers. 
Written  from  the  standpoint  of  the  practitioner,  the  aim  of  the  work  is  to  facili- 
tate the  application  of  knowledge  to  the  prevention,  the  cure,  and  the  allevia- 
tion of  disease.  The  endeavor  throughout  has  been  to  conform  to  the  title  of 
the  book — Applied  Therapeutics — to  indicate  the  course  of  treatment  to  be 
pursued  at  the  bedside,  rather  than  to  name  a  list  of  drugs  that  have  been  used 
at  one  time  or  another. 

The  list  of  contributors  comprises  the  names  of  many  who  have  acquired  dis- 
tinction as  practitioners  and  teachers  of  practice,  of  clinical  medicine,  and  of 
the  specialties^ 

CONTRIBUTORS : 


Dr.  I.  E.  Atkinson,  Baltimore,  Md. 
Sanger  Brown,  Chicago,  111. 
John  B.  Chapin,  Philadelphia,  Pa. 
William  C.  Dabney,  Charlottesville,  Va. 
John  Chalmers  DaCosta,  Philada.,  Pa. 
I.  N.  Danforth,  Chicago,  111. 
John  L.  Dawson,  Jr.,  Charleston,  S.  C. 
F.  X.  Dercum,  Philadelphia,  Pa. 
George  Dock,  Ann  Arbor,  Mich. 
Robert  T.  Edes,  Jamaica  Plain,  Mass. 
Augustus  A.  Eshner,  Philadelphia,  Pa. 
I.  T.  Eskridge,  Denver,  Col. 
F.  Forchheimer,  Cincinnati,  O. 
Carl  Frese,  Philadelphia,  Pa. 
Edwin  E.  Graham,  Philadelphia,  Pa. 
John  Guiteras,  Philadelphia,  Pa. 
Frederick  P.  Henry,  Philadelphia,  Pa. 
Guy  Hinsdale,  Philadelphia,  Pa. 
Orville  Horwitz,  Philadelphia,  Pa. 
W.  W.  Johnston,  Washington,  D.  C. 
Ernest  Laplace,  Philadelphia,  Pa. 
A.  Laveran,  Pans,  France. 


Dr.  James  Hendrie  Lloyd,  Philadelphia,  Pa. 
John  Noland  Mackenzie,  Baltimore,  Md. 
J.  W.  McLuughlin,  Austin,  Texas. 
A.  Lawrence  Mason,  Boston,  Mass. 
Charles  K.  Mills,  Philadelphia,  Pa. 
John  K.  Mitchell.  Philadelphia,  Pa. 
W.  P.  Northrup,  New  York  City. 
William  Osier,  Baltimore,  Md. 
Frederick  A.  Packard,  Philadelphia,  Pa. 
Theophilus  Parvin,  Philadelphia,  Pa. 
Beaven  Rake,  London,  England. 
E.  O.  Shakespeare,  Philadelphia,  Pa. 
Wharton  Sinkler,  Philadelphia,  Pa. 
Louis  Starr,  Philadelphia,  Pa. 
Henry  W.  Stelwagon,  Philadelphia,  Pa. 
James  Stewart,  Montreal,  Canada. 
Charles  G.  Stockton,  Buffalo,  N.  Y. 
James  Tyson,  Philadelphia,  Pa. 
Victor  C.  Vaughan,  Ann  Arbor,  Mich. 

James  T.  Whittaker,  Cincinnati,  O. 
.  C.  Wilson,  Philadelphia,  Pa. 


"  As  a  work  either  for  study  or  reference  it  will  be  of  great  value  to  the  practitioner,  as 
it  is  virtually  an  exposition  of  such  clinical  therapeutics  as  experience  has  taught  to  be  of 
the  most  value.  Taking  it  all  in  all,  no  recent  publication  on  therapeutics  can  be  compared 
with  this  one  in  practical  value  to  the  working  physician."  —  Chicago  Clinical  Review. 

"The  whole  field  of  medicine  has  been  well  covered.  The  work  is  thoroughly  practical, 
and  while  it  is  intended  for  practitioners  and  students,  it  is  a  better  book  for  the  general 
practitioner  than  for  the  student.  The  young  practitioner  especially  will  find  it  extremely 
suggestive  and  helpfuL" — The  Indian  Lancet. 


CATALOGUE    OF  MEDICAL    WORKS. 


*AN  AMERICAN  TEXT-BOOK  OF  OBSTETRICS.  Edited  by 
RICHARD  C.  NORRIS,  M.  D. ;  Art  Editor,  ROBERT  L.  DICKINSON,  M.  D. 
One  handsome  octavo  volume  of  over  1000  pages,  with  nearly  900  colored 
and  half-tone  illustrations.  Prices:  Cloth,  $7.00;  Sheep  or  Half-Morocco, 
$8.00. 

The  advent  of  each  successive  volume  of  the  series  of  the  AMERICAN  TEXT- 
BOOKS has  been  signalized  by  the  most  flattering  comment  from  both  the  Press 
and  the  Profession.  The  high  consideration  received  by  these  text-books,  and 
their  attainment  to  an  authoritative  position  in  current  medical  literature,  have 
been  matters  of  deep  international  interest,  which  finds  its  fullest  expression  in 
the  demand  for  these  publications  from  all  parts  of  the  civilized  world. 

In  the  preparation  of  the  "AMERICAN  TEXT-BOOK  OF  OBSTETRICS"  the 
editor  has  called  to  his  aid  proficient  collaborators  whose  professional  prominence 
entitles  them  to  recognition,  and  whose  disquisitions  exemplify  Practical 
Obstetrics.  White  these  writers  were  each  assigned  special  themes  for  dis- 
cussion, the  correlation  of  the  subject-matter  is,  nevertheless,  such  as  ensures 
logical  connection  in  treatment,  the  deductions  of  which  thoroughly  represent 
the  latest  advances  in  the  science,  and  which  elucidate  the  best  modern  methods 
of  procedure. 

The  more  conspicuous  feature  of  the  treatise  is  its  wealth  of  illustrative 
matier.  The  production  of  the  illustrations  had  been  in  progress  for  several 
years,  under  the  personal  supervision  of  Robert  L.  Dickinson,  M.  D.,  to  whose 
artistic  judgment  and  professional  experience  is  due  the  most  sumptuously 
illustrated  work  of  the  period.  By  means  of  the  photographic  art,  combined 
with  the  skill  of  the  artist  and  draughtsman,  conventional  illustration  is  super- 
seded by  rational  methods  of  delineation. 

Furthermore,  the  volume  is  a  revelation  as  to  the  possibilities  that  may  be 
reached  in  mechanical  execution,  through  the  unsparing  hand  of  its  publisher. 


CONTRIBUTORS : 


Dr.  James  C.  Cameron. 
Edward  P.  Davis. 
Robert  L.  Dickinson. 
Charles  Warrington  Earle. 
James  H.  Etheridge. 
Henry  J.  Garricues. 
Barton  Cooke  Hirst. 
Charles  Jewett. 


Dr.  Howard  A.  Kelly. 
Richard  C.  Norris. 
Chauncey  D.  Palmer. 
Theophilus  Parvin. 
George  A.  Piersol. 
Edward  Reynolds. 
Henry  Schwarz. 


"  At  first  glance  we  are  overwhelmed  by  the  magnitude  of  this  work  in  several  respects, 
viz.  :  First,  by  the  size  of  the  volume,  then  by  the  array  of  eminent  teachers  in  this  depart- 
ment who  have  taken  part  in  its  production,  then  by  the  profuseness  and  character  of  the 
illustrations,  and  last,  but  not  least,  the  conciseness  and  clearness  with  which  the  text  is  ren- 
dered. This  is  an  entirely  new  composition,  embodying  the  highest  knowledge  of  the  art  as 
it  stands  to-day  by  authors  who  occupy  the  front  rank  in  their  specialty,  and  there  are  many 
of  them.  We  cannot  turn  over  these  pages  without  being  struck  by  the  superb  illustrations 
which  adorn  so  many  of  them.  We  are  confident  that  this  most  practical  work  will  find 
instant  appreciation  by  practitioners  as  well  as  students." — New  York  Medical  Times. 

Permit  me  to  say  that  your  American  Text-Book  of  Obstetrics  is  the  most  magnificent 
medical  work  that  1  have  ever  seen.  I  congratulate  you  and  thank  you  for  this  superb  work; 
which  alone  is  sufficient  to  place  you  first  in  the  ranks  of  medical  publishers. 

With  profound  respect  I  am  sincerely  yours,  ALEX.  J.  C.  SKBNB. 


8 


W.   B.   SAUNDERV 


*AN  AMERICAN  TEXT-BOOK  OF  THE  THEORY  AND 
PRACTICE  OF  MEDICINE.  By  American  Teachers.  Edited 
by  WILLIAM  PEPPER,  M.  1).,  J.L.D.,  Provost  and  Professor  of  the  Theory 
and  Practice  of  Medicine  and  of  Clinical  Medicine  in  the  University  of 
Pennsylvania.  Complete  in  two  handsome  royal-octavo  volumes  of  -about 
looo  pages  each,  with  illustrations  to  elucidate  the  text  wherever  necessary. 
Price  per  Volume :  Cloth,  $5.00  net;  Sheep  or  Half-Morocco,  $6.00  net. 

VOLUME  I.  CONTAINS: 


Hygiene. — Fevers  (Ephemeral,  Simple  Con- 
tinued, Typhus,  Typhoid,  Epidemic  Cerebrc- 
spinal  Meningitis,  and  Relapsing). — Scarla- 
tina, Measles,  Rotheln,  Variola,  Varioloid, 
Vaccinia.Varicella,  Mumps, Whooping-cough, 
Anthrax,  Hydrophobia,  Trichinosis,  Actino- 


mycosis,  Glanders,  and  Tetanus. — Tubercu- 
losis, Scrofula,  Syphilis,  Diphtheria,  Erysipe- 
las, Malaria,  Cholera,  and  Yellow  Fever. — • 
Nervous,  Muscular,  and  Mental  Diseases  etc. 


VOLUME   II.  CONTAINS: 


Urine  (Chemistry  and  Microscopy). — Kid- 
ney and  Lungs. — Air-passages  (Larynx  and 
Bronchi)  and  Pleura. — Pharynx,  CEsophagus, 
Stomach  and  Intestines  (including  Intestinal 
Parasites),  Heart,  Aorta,  Arteries  and  Veins. 


— Peritoneum,  Liver, and  Pancreas. — Diathet- 
ic  Diseases  (Rheumatism,  Rheumatoid  Ar- 
thritis, Gout,  Lithxmia,  and  Diabetes.) — 
Blood  and  Spleen.— Inflammation,  Embolism, 
Thrombosis,  Fever,  and  Bacteriology. 


The  articles  are  not  written  as  though  addressed  to  students  in  lectures,  but 
are  exhaustive  descriptions  of  diseases,  with  the  newest  facts  as  regards  Causa- 
tion, Symptomatology,  Diagnosis,  Prognosis,  and  Treatment,  including  a  large 
number  of  approved  formulae.  The  recent  advances  made  in  the  study 
of  the  bacterial  origin  of  various  diseases  are  fully  described,  as  well  as  the 
bearing  of  the  knowledge  so  gained  upon  prevention  and  cure.  The  subjects 
of  Bacteriology  as  a  whole  and  of  Immunity  are  fully  considered  in  a  separate 
section. 

Methods  of  diagnosis  are  given  the  most  minute  and  careful  attention,  thus 
enabling  the  reader  to  learn  the  very  latest  methods  of  investigation  without 
consulting  works  specially  devoted  to  the  subject. 


CONTRIBUTORS : 


Dr. 


I.  S.  Billings,  Philadelphia. 
Francis  Delafield,  New  York. 
Reginald  H.  Fitz,  Boston. 
James  W.  Holland,  Philadelphia. 
Henry  M.  Lyman,  Chicago. 
William  Osier,  Baltimore. 


Dr.  William  Pepper,  Philadelphia. 
W.  Oilman  Thompson,  New  York. 
W.  H.  Welch,  Baltimore. 


"  We  reviewed  the  first  volume  of  this  work,  and  said  :  '  It  is  undoubtedly  one  of  the  best 
text-books  on*  the  practice  of  medicine  which  we  possess.'  A  consideration  of  the  second 
and  last  volume  leads  us  to  modify  that  verdict  and  to  say  that  the  completed  work  is,  in  our 
opinion,  THB  BEST  of  its  kind  it  has  ever  been  our  fortune  to  see.  It  is  complete,  thorough, 
accurate,  and  clear.  It  is  well  written,  well  arranged,  well  printed,  well  illustrated,  and  well 
bound.  It  is  a  model  of  what  the  modern  text-book  should  be." — New  York  Medical  Journal. 

"  A  library  upon  modern  medical  art.  The  work  must  promote  the  wider  diffusion  of 
sound  knowledge." — American  Lancet, 

"  A  trusty  counsellor  for  the  practitioner  or  senior  student,  on  which  he  may  implicitly 
rtly."—  Edinburgh.  Medical  Journal. 


CATALOGUE    OF  MEDICAL    WORKS. 


*AN  AMERICAN  TEXT-BOOK  OF  SURGERY.  Edited  by  WIL- 
LIAM W.  KEEN,  M.D.,  LL.D.,  and  J.  WILLIAM  WHITE,  M.  D.,  PH.  D. 
Forming  one  handsome  royal  octavo  volume  of  1230  pages  (lox  7  inches), 
with  496  wood-cuts  in  text,  and  37  colored  and  half-tone  plates,  many  of 
them  engraved  from  original  photographs  and  drawings  furnished  by  the 
authors.  Price:  Cloth,  $7.00  net ;  Sheep  or  Half  Morocco,  $8.00  net. 

THIRD  EDITION,  THOROUGHLY  REVISED. 

The  want  of  a  text-book  which  could  be  used  by  the  practitioner  and  at  the 
same  time  be  recommended  to  the  medical  student  has  been  deeply  felt,  espe- 
cially by  teachers  of  surgery;  hence,  when  it  was  suggested  to  a  number  of 
these  that  it  would  be  well  to  unite  in  preparing  a  text-book  of  this  description, 
great  unanimity  of  opinion  was  found  to  exist,  and  the  gentlemen  below  named 
gladly  consented  to  join  in  its  production.  While  there  is  no  distinctive  Amer- ' 
ican  Surgery,  yet  America  has  contributed  very  largely  to  the  progress  of  modern 
surgery,  and  among  the  foremost  of  those  who  have  aided  in  developing  this  art 
and  science  will  be  found  the  authors  of  the  present  volume.  All  of  them  are 
teachers  of  surgery  in  leading  medical  schools  and  hospitals  in  the  United  States 
and  Canada. 

Especial  prominence  has  been  given  to  Surgical  Bacteriology,  a  feature  which 
is  believed  to  be  unique  in  a  surgical  text-book  in  the  English  language.  Asep- 
sis and  Antisepsis  have  received  particular  attention.  The  text  is  brought  well 
up  to  date  in  such  important  branches  as  cerebral,  spinal,  intestinal,  and  pelvic 
surgery,  the  most  important  and  newest  operations  in  these  departments  being 
described  and  illustrated. 

The  text  of  the  entire  book  has  been  submitted  to  all  the  authors  for  their 
mutual  criticism  and  revision — an  idea  in  book-making  that  is  entirely  new  and 
original.  The  book  as  a  whole,  therefore,  expresses  on  all  the  important  sur- 
gical topics  of  the  day  the  consensus  of  opinion  of  the  eminent  surgeons  who 
have  joined  in  its  preparation. 

One  of  the  most  attractive  features  of  the  book  is  its  illustrations.  Very 
many  of  them  are  original  and  faithful  reproductions  of  photographs  taken 
directly  from  patients  or  from  specimens. 

CONTRIBUTORS : 


Dr.  Phineas  S.  Conner,  Cincinnati. 
Frederic  S.  Dennis,  New  York. 
William  W.  Keen,  Philadelphia. 
Charles  B.  Nancrede,  Ann  Arbor,  Mich. 
Roswell  Park,  Buffalo,  New  York. 
Lewis  S.  Pitcher,  New  York. 


Dr.  Nicholas  Senn,  Chicago. 

Francis  J.  Shepherd,  Montreal,  Canada. 
Lewis  A.  Slimson,  New  York. 

J.  Collins  Warren,  Boston. 
.  William  White,  Philadelphia. 


London  Lancet. 


10  IV.   B.   SAUNDERS1 


*AN  AMERICAN  TEXT-BOOK  OF  GYNECOLOGY,  MEDICAL 
AND  SURGICAL,  for  the  use  of  Students  and  Practitioner*. 
Edited  by  J.  M.  UAI.DV.  M.  I).  Forming  a  handsome  royal-octavo  volume 
of  718  pages,  with  341  illustrations  in  the  text  and  38  colored  and  half- 
tone plates.  Trices:  Cloth,  $6.00  net;  Sheep  or  Half-Morocco,  #7.00  net. 

SECOND  EDITION,  THOROUGHLY  REVISED. 

In  this  volume  all  anatomical  descriptions,  excepting  those  essential  to  a  clear 
understanding  of  the  text,  have  been  omitted,  the  illustrations  being  largely  de- 
pended upon  to  elucidate  the  anatomy  of  the  parts.  This  work,  which  is 
thoroughly  practical  in  its  teachings,  is  intended,  as  its  title  implies,  to  be  a 
working  text-book  for  physicians  and  students.  A  clear  line  of  treatment  has 
been  laid  down  in  every  case,  and  although  no  attempt  has  been  made  to  dis- 
cuss mooted  points,  still  the  most  important  of  these  have  been  noted  and  ex- 
plained. The  operations  recommended  are  fully  illustrated,  so  that  the  reader, 
having  a  picture  of  the  procedure  described  in  the  text  under  his  eye,  cannot  fail 
to  grasp  the  idea.  All  extraneous  matter  and  discussions  have  been  carefully 
excluded,  the  attempt  being  made  to  allow  no  unnecessary  details  to  cumber 
the  text.  The  subject-matter  is  brought  up  to  date  at  every  point,  and  the 
work  is  as  nearly  as  possible  the  combined  opinions  of  the  ten  specialists  who 
figure  as  the  authors. 

In  the  revised  edition  much  new  material  has  been  added,  and  some  of  the 
old  eliminated  or  modified.  More  than  forty  of  the  old  illustrations  have  been 
replaced  by  new  ones,  which  add  very  materially  to  the  elucidation  of  the 
text,  as  they  picture  methods,  not  specimens.  The  chapters  on  technique  and 
after-treatment  have  been  considerably  enlarged,  and  the  portions  devoted  to 
plastic  work  have  been  so  greatly  improred  as  to  be  practically  new.  Hyste- 
rectomy has  been  rewritten,  and  all  the  descriptions  of  operative  procedures 
have  been  carefully  revised  and  fully  illustrated. 


CONTRIBUTORS : 


Dr.  Henry  T.  Byford. 
John  M.  Baldy. 
Edwin  Cragin. 
I.  H.  Etheridge. 
William  Goodell. 


Dr.  Howard  A.  Kelly. 
Florian  Krug. 
E.  E.  Montgomery. 
William  R.  Pryor. 
George  M.  Tuttle. 


"  The  most  notable  contribution  to  gynecological  literature  since  1887,  ....  and  the  most 
complete  exponent  of  gynecology  which  we  have.  No  subject  seems  to  have  been  neglected, 
....  and  the  gynecologist  and  surgeon,  and  the  general  practitioner  who  has  any  desire 
to  practise  diseases  of  women,  will  find  it  of  practical  value.  In  the  matter  of  illustrations 
and  plates  the  book  surpasses  anything  we  have  seen." — Boston  Medical  and  Surgical 
Journal. 

"  A  thoroughly  modern  text-book,  and  gives  reliable  and  well-tempered  advice  and  in- 
struction."— Edinburgh  Medical  Journal. 

"  The  harmony  of  its  conclusions  and  the  homogeneity  of  its  style  give  it  an  individuality 
which  suggests  a  single  rather  than  a  multiple  authorship."— Annats  of  Surgery. 

"  It  must  command  attention  and  respect  as  a  worthy  representation  of  our  advanced 
clinical  teaching." — American  Journal  of  Medical  Sciencet. 


CATALOGUE    OF  MEDICAL    WORKS. 


II 


*AN  AMERICAN  TEXT-BOOK  OF  THE  DISEASES  OF  CHIL- 
DREN. By  American  Teachers.  Edited  by  Louis  STARR,  M.  D., 
assisted  by  THOMPSON  S.  WESTCOTT,  M.  D.  In  one  handsome  royal-8vo 
volume  of  1244  pages,  profusely  illustrated  with  wood-cuts,  half-tone  and 
colored  plates.  Net  Prices:  Cloth,  $7.00;  Sheep  or  Half-Morocco,  $8.00. 

SECOND  EDITION,  REVISED  AND  ENLARGED. 

The  plan  of  this  work  embraces  a  series  of  original  articles  written  by  some 
sixty  well-known  podiatrists,  representing  collectively  the  teachings  of  the  most 
prominent  medical  schools  and  colleges  of  America.  The  work  is  intended  to 
be  a  PRACTICAL  book,  suitable  for  constant  and  handy  reference  by  the  practi- 
tioner and  the  advanced  student. 

Especial  attention  has  been  given  to  the  latest  accepted  teachings  upon  the 
etiology,  symptoms,  pathology,  diagnosis,  and  treatment  of  the  disorders  of  chil- 
dren, with  the  introduction  of  many  special  formulae  and  therapeutic  procedures. 

In  this  new  edition  the  whole  subject  matter  has  been  carefully  revised,  new 
articles  added,  some  original  papers  emended,  and  a  number  entirely  rewritten. 
The  new  articles  include  "Modified  Milk  and  Percentage  Milk-Mixtures," 
"  Lithemia,"  and  a  section  on  "  Orthopedics."  Those  rewritten  are  "  Typhoid 
Fever,"  "Rubella,"  "Chicken-pox,"  "Tuberculous  Meningitis,"  "  Hydroceph- 
alus,"  and  "Scurvy;"  while  extensive  revision  has  been  made  in  "Infant 
Feeding,"  "  Measles,"  "  Diphtheria,"  and  "  Cretinism."  The  volume  has  thus 
been  much  increased  in  size  by  the  introduction  of  fresh  material. 

CONTRIBUTORS  I 


Dr.  S.  S.  Adams,  Washington. 

John  Ashhurst,  Jr.,  Philadelphia. 
A.  D.  Blackader,  Montreal,  Canada. 
David  Bovaird,  New  York. 
Dillon  Brown,  New  York. 
Edward  M.  Buckingham,  Boston. 
Charles  W.  Burr,  Philadelphia. 
W.  E.  Casselberry,  Chicago. 
Henry  Dwight  Chapin,  New  York. 
W.  S.  Christopher,  Chicago. 
Archibald  Church,  Chicago. 
Floyd  M.  Crandall,  New  York. 
Andrew  F.  Currier,  New  York. 
Roland  G.  Curtin,  Philadelphia 
1.  M.  DaCosta,  Philadelphia. 
I.  N.  Danforth,  Chicago. 
Edward  P.  Davis,  Philadelphia. 
John  B.  Deaver,  Philadelphia. 
G.  E.  de  Schweinitz,  Philadelphia. 
John  Doming,  New  York. 
Charles  Warrington  Earle,  Chicago. 
Wm.  A.  Edwards,  San  Diego,  Cal. 
F.  Forchheimer,  Cincinnati. 
I.  Henry  Fruitnight,  New  York. 
J.  P.  Crozer  Griffith,  Philadelphia. 
W.  A.  Hardaway.  St.  Louis. 
M.  P    Hatfield,  Chicago. 
Barton  Cooke  Hirst,  Philadelphia. 
H.  Illoway,  Cincinnati. 
Henry  Jackson,  Boston. 
Charles  G.  Jennings,  Detroit. 
Henry  Koplik.  New  York. 


Dr.  Thomas  S.  Latimer,  Baltimore. 
Albert  R.  Leeds,  Hoboken,  N.  J. 
J.  Hendrie  Lloyd,  Philadelphia. 
George  Roe  Lockwood,  New  York. 
Henry  M.  Lyman,  Chicago. 
Francis  T.  Miles,  Baltimore. 
Charles  K    Mills,  Philadelphia. 
James  E    Moore,  Minneapolis. 
F.  Gordon  Morrill,  Boston. 
John  H.  Musser,  Philadelphia. 
Thomas  R.  Neilson,  Philadelphia 
W.  P.  Northrup,  New  York. 
William  Osier,  Baltimore. 
Frederick  A.  Packard,  Philadelphia. 
William  Pepper,  Philadelphia. 
Frederick  Peterson,  New  York. 
W.  T.  Plant,  Syracuse,  New  York. 
William  M.  Powell,  Atlantic  City. 
B.  K.  Rachford,  Cincinnati. 
B.  Alexander  Randall,  Philadelphia. 
Edward  O.  Shakespeare,  Philadelphia 
F.  C.  Shattuck,  Boston. 
I.  Lewis  Smith,  New  York. 
Louis  Starr,  Philadelphia. 
M.  Allen  Starr,  New  York. 
Charles  W.  Townsend,  Boston. 
James  Tyson,  Philadelphia. 
W.  S.  Thayer,  Baltimore. 
Victor  C.  Vaughan,  Ann  Arbor,  Mich 
Thompson  S.  Westcott,  Philadelphia. 
Henry  R.  Wharton,  Philadelphia. 
J    William  White,  Philadelphia. 
I    C.  Wilson,  Philadelphia. 


12 


W.   B.   SAUNDEKS' 


*AN  AMERICAN  TEXT-BOOK  OF  GENITO-URINARY  AND 
SKIN  DISEASES.  JJy  47  Eminent  Specialists  and  Teachers.  Edited 
by  L.  BOI.TUN  I!AN<;S,  M.  I).,  Professor  of  Clenito-Urinary  Surgery,  Uni- 
'y  and  Bellevue  Hospital  Medical  College,  New  York;  and  \V.  A. 
11  \KDA\VAY,  M.  D.,  Professor  of  Diseases  of  the  Skin,  Missouri  Medical 
College.  Imperial  octavo  volume  of  1229  pages,  with  300  engravings  and 
20  full-page  colored  plates.  Cloth,  $7.00  net;  Sheep  or  Half  Morocco, 
$8.00  net. 

This  addition  to  the  series  of  "American  Text-Iiooks,"  it  is  confidently  be- 
lieved, will  meet  the  requirements  of  both  students  and  practitioner*,  giving,  as 
it  does,  a  comprehensive  and  detailed  presentation  of  the  Diseases  of  the 
Genito-Urinary  Organs,  of  the  Venereal  Diseases,  and  of  the  Affections  of  the 
Skin. 

Having  secured  the  collaboration  of  well-known  authorities  in  the  branches 
represented  in  the  undertaking,  the  editors  have  not  restricted  the  contributors 
ii.  regard  to  the  particular  views  set  forth,  but  have  ollrn-d  every  facility  for  the 
free  expression  of  their  individual  opinions.  The  work  will  therefore  be  found 
to  be  original,  yet  homogeneous  and  fully  representative  of  the  several  depart- 
ments of  medical  science  with  which  it  is  concerned. 


4  OMKIItl   IOKS: 


Dr.  Chas.  W.  Allen,  New  York. 
I.  E.  Atkinson,  Baltimore. 
L   Kolton  Bangs,  New  York. 
P.  R.  Bolton,  New  York. 
Lewis  C.  Bosher,  Richmond,  Va. 
John  T.  Bowen,  Boston. 
J.  Abbott  Cantrell.  Philadelphia. 
William  T.  Corlett,  Cleveland,  Ohio. 
B.  Farquhar  Curtis,  New  York. 
Condict  W.  Cutler,  New  York. 
Isadore  Dyer,  New  Orleans. 
Christian  Fenger,  Chicago. 
John  A.  Fordyce,  New  York. 
Eugene  Fuller,  New  York. 
R.  H.  Greene,  New  York. 
Joseph  Grindon,  St.  Louis. 
Graeme  M.  Hammond,  New  York. 
W.  A.  Hardaway,  St.  Louis. 
M.  B.  Hartzell,  Philadelphia. 
Louis  Heitzmann,  New  York. 
James  S.  Howe,  Boston. 
George  T.  Jackson,  New  York. 
Abraham  Jacob!,  New  York. 
James  C.  Johnston,  New  York. 


Dr.  Hi  unarm  G.  Klotz,  New  York. 
J.  H.  Linsley,  Burlington,  Vt. 
G.  F.  Lydston,  Chicago. 
Hartwell  N.  Lyon,  St.  Louis. 
Edward  Martin,  Philadelphia. 
,    D.  G.  Montgomery,  San   Francisco. 
(.lines  Pedersen,  New  York. 
S.  Pollitzer,  New  York. 
Thomas  R.  Pooley,  New  York. 
A.  R.  Robinson,  New  York. 
A.  E.  Rtgensburger,  San  Francisco. 
Francis  J.  Shepherd,  Montreal,  Can. 
S.  C.  Stanton,  Chicago,  111. 
Emmanuel  J.  Stout.  Philadelphia. 
Alnn/o  E.  Taylor.  Philadelphia. 
Robert  W.  Taylor,  New  York. 
Paul  Thorndike,  Boston. 
H.  Tuholske,  St.  Louis. 
Arthur  Van  Harlingen,  Philadelphia. 
Francis  S.  Watson,  Boston. 
J    William  White.  Philadelphia. 
J.  McF.  Winfield,  Brooklyn 
Alfred  C.  Wood,  Philadelphia. 


"This  voluminous  work  is  thoroughly  up  to  date,  and  the  chapters  on  genito-urinary  dis- 
eases are  especially  valuable.  The  illustrations  are  fine  and  are  mostly  original.  The  section 
on  dermatology  is  concise  and  in  every  way  admirable."— Journal  of  the  American  Medical 
Association. 

"This  volume  is  one  of  the  best  yet  issued  of  the  publisher's  series  of  'American  Text- 
Books.'  The  list  of  contributors  represents  an  extraordinary  array  of  talent  and  ex!' n,l. d 
experience.  The  book  will  easily  take  the  place  in  comprehensiveness  and  value  of  the 
half  dozen  or  more  costly  works  on  these  subjects  which  have  hitherto  been  necessary  to  a 
well-equipped  library." — Nau  York  l\>lyclinic. 


CATALOGUE    OF  MEDICAL    WORKS. 


*  AN  AMERICAN  TEXT-BOOK  OF  DISEASES  OF  THE  EYE, 
EAR,  NOSE,  AND  THROAT.    Edited  by  GEORGE  E.  DE  SCHWEINITZ, 

A.  M.,  M.  D.,  Professor  of  Ophthalmology,  Jefferson  Medical  College;  and 

B.  ALEXANDER  RANDALL,  A.  M.,  M.  D.,  Clinical  Professor  of  Diseases  of 
the    Ear,    University    of   Pennsylvania.     One    handsome    imperial    octavo 
volume   of   1251    pages;    766   illustrations,  59  of  them  colored.     Prices: 
Cloth,  37.00  net;  Sheep  or  Half- Morocco,  $8.00  net. 

Just  Issued. 

The  present  work  is  the  only  book  ever  published  embracing  diseases  of  the 
intimately  related  organs  of  the  eye,  ear,  nose,  and  throat.  Its  special  claim 
to  favor  is  based  on  encyclopedic,  authoritative,  and  practical  treatment  of  the 
subjects. 

Each  section  of  the  book  has  been  entrusted  to  an  author  who  is  specially 
identified  with  the  subject  on  which  he  writes,  and  who  therefore  presents  his 
case  in  the  manner  of  an  expert.  'Uniformity  is  secured  and  overlapping  pre- 
vented by  careful  editing  and  by  a  system  of  cross-references  which  forms  a 
special  feature  of  the  volume,  enabling  the  reader  to  come  into  touch  with  all 
that  is  said  on  any  subject  in  different  portions  of  the  book. 

Particular  emphasis  is  laid  on  the  most  approved  methods  of  treatment,  so 
that  the  book  shall  be  one  to  which  the  student  and  practitioner  can  refer  for 
information  in  practical  work.  Anatomical  and  physiological  problems,  also, 
are  fully  discussed  for  the  benefit  of  those  who  desire  to  investigate  the  more 
abstruse  problems  of  the  subject. 


CONTRIBUTORS: 


Dr.  Henry  A.  Alderton,  Brooklyn. 
Harrison  Allen,  Philadelphia. 
Frank  Allporc,  Chicago. 
Morris  J.  Asch.  NTew  York. 
S.  C.  Ayres,  Cincinnati. 
R.  O.  Beard,  Minneapolis. 
Clarence  J.  Blake.  Boston. 
Arthur  A.  Bliss,  Philadelphia. 
Albert  P.  Brubaker,  Philadelphia. 
J.  H.  Bryan,  Washington,  D.  C. 
Albert  H.  Buck,  New  York. 
F.  Buller,  Montreal,  Can. 
Swan  M.  Burnett,  Washington,  D.  C. 
Flemming  Carrow,  Ann  Arbor,  Mich. 
W.  E.  Casselberry,  Chicago. 
Colman  W.  Cutler,  New  York. 
Edward  B.  Dench,  New  York. 
William  S.  Dennett,  New  York. 
George  E.  de  Schweinitz,  Philadelphia. 
Alexander  Duane,  New  York. 
John  W.  Farlow,  Boston,  Mass. 
Walter  J.  Freeman,  Philadelphia. 
H.  Gifford.  Omaha,  Neb. 
W.  C.  Glasgow.  St.  Louis. 
J.  Orne  Green,  Boston. 
Ward  A.  Holden,  New  York. 
Christian  R.  Holmes,  Cincinnati. 
William  E.  Hopkins,  San  Francisco. 
F.  C.  Hotz,  Chicago. 
Lucien  Howe,  Buffalo,  N.  Y. 


Dr.  Alvin  A.  Hubbell,  Buffalo,  N.  Y. 


Chas.  W.  Kollock,  Charleston,  S.  C. 
G.  A.  Leland,  Boston. 
J.  A.  Lippincott,  Pittsburg,  Pa. 
G.  Hudson  Makuen,  Philadelphia. 
John  H.  McCollom,  Boston. 
H.  G.  Miller,  Providence,  R.  I. 
B.  L.  Milliken,  Cleveland,  Ohio. 
Robert  C.  Myles,  New  York. 
James  E.  Newcomb,  New  York. 
R.  J.  Phillips,  Philadelphia 
George  A.  Piersol,  Philadelphia. 
W.  P.  Porcher,  Charleston.  S.  C. 
B.  Alex.  Randall,  Philadelphia. 
Robert  L.  Randolph,  Baltimore. 
John  O.  Roe,  Rochester,  N.  Y. 
Charles  E.  de  M.  Sajous,  Philadelphia. 
J.  E.  Sheppard,  Brooklyn,  N.  Y. 
E.  L.  Shurly.  Detroit,  Mich. 
William  M.  Sweet,  Philadelphia. 
Samuel  Theobald.  Baltimore,  Md. 
A.  G.  Thomson,  Philadelphia. 
Clarence  A.  Veasey,  Philadelphia. 
John  E.  Weeks,  New  York. 
Casey  A.  Wood,  Chicago,  111. 
Jonathan  Wright,  Brooklyn. 
H.  V.  Wiirdemann,  Milwaukee,  Wis. 


W.   B.   SAUNDERS' 


*AN  AMERICAN  YEAR-BOOK  OF  MEDICINE  AND  SUR- 
GERY. A  Yearly  Digest  of  Scientific  Progress  and  Authoritative 
Opinion  in  all  branches  of  Medicine  and  Surgery,  drawn  from  journals, 
monographs,  and  text-books  of  the  leading  American  and  Foreign  authors 
and  investigators.  Collected  and  arranged,  with  critical  editorial  com- 
ments, by  eminent  American  specialists  and  teachers,  under  the  general 
editorial  charge  of  GEORGE  M.  GOULD,  M.D.  One  handsome  imperial 
octavo  volume  of  about  1200  pages.  Uniform  in  style,  size,  and  general 
make-up  with  the  "American  Text-Book"  Series.  Cloth,  $6.50  net; 
Half- Morocco,  $7.50  net. 

Now  Ready,  Volumes  for  IfifHi,  1S97,  189ft,  IfifW. 

Notwithstanding  the  rapid  multiplication  of  medical  and  surgical  works,  still 
these  publications  fail  to  meet  fully  the  requirements  of  the  general  physician, 
inasmuch  as  he  feels  the  need  of  something  more  than  mere  text-books  of  well- 
known  principles  of  medical  science. 

This  deficiency  would  best  be  met  by  current  journalistic  literature,  but  most 
practitioners  have  scant  access  to  this  almost  unlimited  source  of  information, 
and  the  busy  practiser  has  but  little  time  to  search  out  in  periodicals  the  many 
interesting  cases  whose  study  would  doubtless  be  of  inestimable  value  in  his 
practice.  Therefore,  a  work  which  places  before  the  physician  in  convenient 
form  an  epitomization  of  this  literature  by  persons  competent  to  pronounce  iipon 

The  Value  of  a  Discovery  or  of  a  Method  of  Treatment 

cannot  but  command  his  highest  appreciation.  It  is  this  critical  and  judicial 
function  that  is  assumed  by  the  Editorial  staff  of  the  "  American  Year-Book 
of  Medicine  and  Surgery." 

CONTRIBUTORS  : 


Dr.  Samuel  W.  Abbott.  Boston. 

John  J.  Abel,  Baltimore. 
.  M.  Baldy,  Philadelphia. 
Charles  H.  Burnett,  Philadelphia. 
Archibald  Church,  Chicago. 
J.  Chalmers  DaCosta,  Philadelphia. 
W.  A.  N.  Dorland,  Philadelphia. 
Louis  A.  Duhring,  Philadelphia. 
I).  L.  Edsall,  Philadelphia. 
Virgil  P.  Gibney,  New  York. 
Henry  A.  Griffin,  New  York. 
John  Guiteras,  Philadelphia. 
C.  A.  Hamann,  Cleveland. 
Alfred  Hand,  Jr.,  Philadelphia. 


Dr.  Howard  E.  Hansell,  Philadelphia. 
M.  B.  Hartzell,  Philadelphia. 
Barton  Cooke  Hirst,  Philadelphia. 
E.  Fletcher  Ingals,  Chicago. 
Wyatt  Johnston,  Montreal. 
W.  W.  Keen,  Philadelphia. 
Henry  G.  Ohls,  Chicago. 
Wendell  Reber,  Philadelphia. 
David  Riesman,  Philadelphia. 
Louis  Starr,  Philadelphia. 
Alfred  Stengel,  Philadelphia. 
G.  N.  Stewart.  Cleveland. 
J.  R.  Tillinghast,  New  York. 
J.  Hilton  Waterman,  New  York. 


"  It  is  difficult  to  know  which  to  admire  most — the  research  and  industry  of  the  distin- 
guished band  of  experts  whom  Dr.  Gould  has  unlisted  in  the  service  of  the  Year-Book,  or  the 
wealth  and  abundance  of  the  contributions  to  every  department  of  science  that  have  been 
deemed  worthy  of  analysis.  ...  It  is  much  more  than  a  mere  compilation  of  abstracts,  for, 
as  each  section  is  entrusted  to  experienced  and  able  contributors,  the  reader  has  the  advan- 
tage of  certain  critical  commentaries  and  expositions  .  .  .  proceeding  from  writers  fully 
qualified  to  perform  these  tasks.  ...  It  is  emphatically  a  book  which  should  find  a  place  in 
every  medical  library,  and  is  in  several  respects  more  useful  than  the  famous  '  Jahrbiicher' 
of  Germany." — London  Lancet. 


CATALOGUE    OF  MEDICAL    WORKS.  15 

*  ANOMALIES  AND  CURIOSITIES  OF  MEDICINE.  By  GEORGE 
M.  GOULD,  M.D.,  and  WALTER  L.  PYLE,  M.D.  An  encyclopedic  collec- 
tion of  are  and  extraordinary  cases  and  of  the  most  striking  instances  of 
abnormality  in  all  branches  of  Medicine  and  Surgery,  derived  from  an  ex- 
haustive research  of  medical  literature  from  its  origin  to  the  present  day, 
abstracted,  classified,  annotated,  and  indexed.  Handsome  imperial  octavo 
volume  of  968  pages,  with  295  engravings  in  the  text,  and  12  full-page 
plates.  Cloth,  $6.00  net ;  Half- Morocco,  $7.00  net. 

Several  years  of  exhaustive  research  have  been  spent  by  the  authors  in  the 
great  medical  libraries  of  the  United  States  and  Europe  in  collecting  the  mate- 
rial for  this  work.  Medical  literature  of  all  ages  and  all  languages  has 
been  carefully  searched,  as  a  glance  at  the  Bibliographic  Index  will  show.  The 
facts,  which  will  be  of  extreme  value  to  the  author  and  lecturer,  have  been 
arranged  and  annotated,  and  full  reference  footnotes  given,  indicating  whence 
they  have  been  obtained. 

In  view  of  the  persistent  and  dominant  interest  in  the  anomalous  and  curious, 
a  thorough  and  systematic  collection  of  this  kind  (the  first  of  which  the 
authors  have  knowledge)  must  have  its  own  peculiar  sphere  of  usefulness. 

As  a  complete  and  authoritative  Book  of  Reference  it  will  be  of  value  not 
only  to  members  of  the  medical  profession,  but  to  all  persons  interested  in  gen- 
eral scientific,  sociologic,  and  medico-legal  topics;  in  fact,  the  general  interest 
of  the  subject  and  the  dearth  of  any  complete  work  upon  it  make  this  volume 
one  of  the  most  important  literary  innovations  of  the  day. 

"  One  of  the  most  valuable  contributions  ever  made  to  medical  literature.  It  is,  so  far  as 
we  know,  absolutely  unique,  and  every  page  is  as  fascinating  as  a  novel.  Not  alone  for  the 
medical  profession  has  this  volume  value  :  it  will  serve  as  a  book  of  reference  for  all  who  are 
interested  in  general  scientific,  sociologic,  or  medico-legal  topics." — Brooklyn  Medical  Jour- 
nal. 

NERVOUS  AND  MENTAL  DISEASES.  By  ARCHIBALD  CHURCH, 
M.  D.,  Professor  of  Clinical  Neurology,  Mental  Diseases,  and  Medical 
Jurisprudence,  Northwestern  University  Medical  School;  and  FREDERICK 
PETERSON,  M.  D.,  Clinical  Professor  of  Mental  Diseases,  Woman's  Medi- 
cal College,  New  York.  Handsome  octavo  volume  of  843  pages,  with 
over  300  illustrations.  Prices:  Cloth,  $5.00  net;  Half-Morocco,  $6.00 
net. 

Just  Issued. 

This  book  is  intended  to  furnish  students  and  practitioners  with  a  practical, 
working  knowledge  of  nervous  and  mental  diseases.  Written  by  men  of  wide 
experience  and  authority,  it  presents  the  many  recent  additions  to  the  subject. 
The  book  is  not  filled  with  an  extended  dissertation  on  anatomy  and  pathology, 
but,  treating  these  points  in  connection  with  special  conditions,  it  lays  particular 
stress  on  methods  of  examination,  diagnosis,  and  treatment.  In  this  respect  the 
work  is  unusually  complete  and  valuable,  laying  down  the  definite  courses  of 
procedure  which  the  authors  have  found  to  be  most  generally  satisfactory. 


//•.    A'.    S.ll'.\'/)I-:KS' 


A  TEXT-BOOK  OF  PATHOLOGY.  Uy  AI.I  KKD  STKNCII,  M.I)., 
1'mlrssor  of  Clinical  Medicine  in  the  University  of  Pennsylvania;  Physi- 
cian l<>  the  Philadelphia  Hospital;  Physician  to  the  Children's  Hospital, 
Philadelphia.  Handsome  octavo  volume  of  848  pages,  with  362  illustra- 
tions, many  of  which  are  in  colors.  Prices:  Cloth,  $4.00  net;  Half- 
Morocco,  #5.00  net. 


Second  Editi 

In  this  work  the  practical  application  of  pathological  facts  to  clinical  medicine 
is  considered  more  fully  than  is  customary  in  works  on  pathology.  While  the 
subject  of  pathology  is  treated  in  the  broadest  way  consistent  with  the  si/c  of 
the  book,  an  effort  has  been  made  to  present  the  subject  from  the  point  of  view 
of  the  clinician.  The  general  relations  of  bacteriology  to  pathology  are  dis- 
1  at  considerable  length,  as  the  importance  of  these  branches  deserves.  It 
will  be  found  that  the  recent  knowledge  is  fully  considered,  as  well  as  older  and 
more  widely-known  facts. 

"  I  consider  the  work  abreast  of  modern  pathology,  and  useful  to  both  students  and  prac- 
titioners. It  presents  in  a  concise  and  well-considered  form  the  essential  facts  of  general  and 
special  pathological  anatomy,  with  more  than  usual  emphasis  upon  pathological  physiology." 
—  WILLIAM  H.  WELCH,  Professor  of  Pathology,  J<>/ins  /Irfkins  University,  Baltimore,  M<{. 

"  I  regard  it  as  the  most  serviceable  text-book  for  students  on  this  subject  yet  written  by 
an  American  author.  "—  L.  HEKTOEN,  Professor  of  1'athology,  Kus/i  Medical  College, 
Chicago,  III. 

A  TEXT-BOOK  OF  OBSTETRICS.  By  BARTON  COOKE  HIRST,  M.D., 
Professor  of  Obstetrics  in  the  University  of  Pennsylvania.  Handsome  oc- 
tavo volume  of  846  pages,  with  618  illustrations  and  seven  colored  plates. 
Prices  :  Cloth,  $5.00  net  ;  Half-Morocco,  $6.00  net. 

This  work,  which  has  been  in  course  of  preparation  for  several  years,  is  in- 
tended as  an  ideal  text-book  for  the  student  no  less  than  an  advanced  treatise 
for  the  obstetrician  and  for  general  practitioners.  It  represents  the  very  latest 
teaching  in  the  practice  of  obstetrics  by  a  man  of  extended  experience  and 
recognized  authority.  The  book  emphasizes  especially,  as  a  work  on  obstetrics 
should,  the  practical  side  of  the  subject,  and  to  this  end  presents  an  unusually 
large  collection  of  illustrations.  A  great  number  of  these  are  new  and  original, 
and  the  whole  collection  will  form  a  complete  atlas  of  obstetrical  practice. 
An  extremely  valuable  feature  of  the  book  is  the  large  number  of  refer- 
ences to  cases,  authorities,  sources,  etc.,  forming,  as  it  does,  a  valuable  bib- 
liography of  the  most  recent  and  authoritative  literature  on  the  subject 
of  obstetrics.  As  already  stated,  this  work  records  the  wide  practical  ex- 
perience of  the  author,  which  fact,  combined  with  the  brilliant  presentation 
of  the  subject,  will  doubtless  render  this  one  of  the  most  notable  books  on 
obstetrics  that  has  yet  appeared. 

"  The  illustrations  are  numerous  and  are  works  of  art,  many  of  them  appearing  for  the 
first  time.  The  arrangement  of  the  subject-matter,  the  foot-notes,  and  index  are  beyond 
criticism.  The  author's  style,  though  condensed,  is  singularly  clear,  so  that  it  is  never 
necessary  to  rc-rcad  a  sentence  in  order  to  grasp  its  meaning.  As  a  true  model  of  what  a 
modern  text-book  in  obstetrics  should  be,  we  feel  justified  in  affirming  that  Dr.  Hirst's 
book  is  without  a  rival."—  New  York  Medical  Record. 


CATALOGUE    OF  MEDICAL    WORKS. 


A    TEXT-BOOK    OF    THE    PRACTICE    OF    MEDICINE.      By 

JAMKS  M.  ANDERS,  M.D.,  PH.D.,  LL.D.,  Professor  of  the  Practice  of 
Medicine  and  of  Clinical  Medicine,  Medico-Chirurgical  College,  Philadel- 
phia. In  one  handsome  octavo  volume  of  1287  pages,  fully  illustrated. 
Cloth,  ^5.50  net  ;  Sheep  or  Half-  Morocco,  $6.50  net. 

THIRD   EDITION,  THOROUGHLY   REVISED. 

This  work  gives  in  a  comprehensive  .manner  the  results  of  the  latest  scientific 
studies  bearing  upon  medical  affections,  and  portrays  with  rare  force  and  clear- 
ness the  clinical  pictures  of  the  different  diseases  considered.  The  practical 
points,  particularly  with  reference  to  diagnosis  and  treatment,  are  completely 
stated  and  are  presented  in  a  most  convenient  form  ;  for  example,  the  differ- 
ential diagnosis  lias  in  many  instances  been  tabulated,  no  less  than  fifty-six 
diagnostic  tables  being  given. 

The  first  edition  of  this  work  having  been  exhausted  in  so  short  a  time,  the 
author  has  not  found  it  necessary  to  make  an  extensive  revision,  but  has  simply 
availed  himself  of  the  opportunity  to  make  a  few  changes  of  minor  importance. 

."  It  is  an  excellent  book  —  concise,  comprehensive,  thorough,  and  up  to  date.  It  is  a 
credit  to  you;  but,  more  than  that,  it  is  a  credit  to  the  profession  of  Philadelphia  —  to  us." 
—  JAMES  C.  WILSON,  Professor  of  the  Practice  of  Medicine  and  Clinical  Medicine,  Jeffer- 
son Medical  College,  Philadelphia. 

"  I  consider  Dr.  Anders'  book  not  only  the  best  late  work  on  Medical  Practice,  but  by  far 
the  best  that  has  ever  been  published.  It  is  concise,  systematic,  thorough,  and  fully  up  to 
date  in  everything.  I  consider  it  a  great  credit  to  both  the  author  and  the  publisher."  —  A. 
C.  COWPERTHWAITE,  President  of  the  Illinois  Homeopathic  Medical  Association. 

DISEASES  OF  THE  STOMACH.  By  WILLIAM  W.  VAN  VAI.ZAH, 
M.  D.,  Professor  of  General  Medicine  and  Diseases  of  the  Digestive  System 
and  the  Blood,  New  York  Polyclinic  ;  and  J.  DOUGLAS  NISBET,  M.  D., 
Adjunct  Professor  of  General  Medicine  and  Diseases  of  the  Digestive  Sys- 
tem and  the  Blood,  New  York  Polyclinic.  Octavo  volume  of  674  pages, 
illustrated.  Cloth,  $3.50  net. 

An  eminently  practical  book,  intended  as  a  guide  to  the  student,  an  aid  to  the 
physician,  and  a  contribution  to  scientific  medicine.  It  aims  to  give  a  complete 
description  of  the  modern  methods  of  diagnosis  and  treatment  of  diseases  of  the 
stomach,  and  to  reconstruct  the  pathology  of  the  stomach  in  keeping  with  the 
revelations  of  scientific  research.  The  book  is  clear,  practical,  and  complete, 
and  contains  the  results  of  the  authors'  investigations  and  of  their  extensive  ex- 
perience as  specialists.  Particular  attention  is  given  to  the  important  subject  of 
dietetic  treatment.  The  diet-lists  are  very  complete,  and  are  so  arranged  that 
selections  can  readily  be  made  to  suit  individual  cases. 

"  This  is  the  most  satisfactory  work  on  the  subject  in  the  English  language."  —  Chicago 
Medical  Recorder. 

"  The  article  on  diet  and  general  medication  is  one  of  the  most  valuable  in  the  book,  and 
should  be  read  by  every  practising  physician."  —  New  York  Medical  Journal. 


1 8  «'.    B.   SAUNDERV 


SURGICAL   DIAGNOSIS   AND    TREATMENT.     By   J.  W.    MAC- 
DONALD,  M.  D.,  Edin.,  F.  R.  (.'.  S.,  Kdin.,  Professor  of  the  Practice  of  Sur- 
gery and  of  Clinical  Surgery  in  Hamline  University  ;  Visiting  Surgeon  to  St. 
Barnabas'  Hospital,  Minneapolis,  etc.     Handsome  octavo  volume  of  800 
pages,  profusely  illustrated.     Cloth,  $5.00  net;  1 1  alf-  Morocco,  $6.00  net. 
This  work  aims  in  a  comprehensive  manner  to  furnish  a  guide  in  matters  of 
surgical  diagnosis.     It  sets  forth  in  a  systematic  way  the  necessities  of  examina- 
tions and  the  proper  methods  of  making  them.     The   various  portions  of  the 
body  are  then  taken  up  in  order  and  the  diseases  and  injuries  thereof  succinctly 
considered  and  the  treatment  briefly  indicated.      Practically  all  the  modern  and 
approved  operations  are  described  with  thoroughness  and  clearness.     The  work 
concludes  with  a  chapter  on  the  use  of  the  RSntgen  rays  in  surgery. 

"The  work  is  brimful  of  just  the  kind  of  practical  information  that  is  useful  alike  to 
students  and  practitioners.  It  is  a  pleasure  to  commend  the  book  because  of  its  intrinsic 
value  to  the  medical  practitioner." — Cincinnati  Lancet-Clinic. 

PATHOLOGICAL  TECHNIQUE.     A  Practical  Manual  for  Laboratory 
Work  in  Pathology,  Bacteriology,  and  Morbid  Anatomy,  with  chapters  on 
Post-Mortem  Technique  and  the  Performance  of  Autopsies.     By  FRANK 
B.  MALLORY,  A.  M.,  M.  D.,  Assistant  Professor  of  Pathology,  Harvard 
University  Medical  School,  Boston;  and  JAMES  II.  WKK;HT,  A.  M.,  M.  !>., 
Instructor  in  Pathology,  Harvard  University  Medical  School,  Boston.     Oc- 
tavo volume  of  396. pages,  handsomely  illustrated.     Cloth,  $2.50  net. 
This  book  is  designed  especially  for  practical  use  in  pathological  laboratories, 
both  as  a  guide  to  beginners  and  as  a  source  of  reference  for  the  advanced.   The 
book  will  also  meet  the  wants  of  practitioners  who  have  opportunity  to  do  general 
pathological  work.     Besides  the  methods  of  post-mortem  examinations  and  of 
bacteriological   and   histological   investigations    connected    with    autopsies,   the 
special   methods   employed   in   clinical   bacteriology  and  pathology  have  been 
fully  discussed. 

"  One  of  the  most  complete  works  on  the  subject,  and  one  which  should  be  in  the  library 
of  every  physician  who  hopes  to  keep  pace  with  (he  great  advances  made  in  pathology."— 
"Journal  of  American  Medical  Association. 

THE  SURGICAL  COMPLICATIONS  AND  SEQUELS  OF  TY- 
PHOID FEVER.     By  WM.  W.  KEEN,  M.  D.,  LL.D.,  Professor  of  the 
Principles  of  Surgery  and  of  Clinical  Surgery,  Jefferson  Medical  College, 
Philadelphia.     Octavo  volume  of  386  pages,  illustrated.    Cloth,  $3.00  net. 
This  monograph  is  the  only  one  in  any  language  covering  the  entire  subject 
of  the  Surgical  Complications  and  Sequels  of  Typhoid   Fever.     The  work  will 
prove  to  be  of  importance  and  interest  not  only  to  the  general  surgeon  and  phy- 
sician, but  also  to  many  specialists — laryngologists,  ophthalmologists,  gynecolo- 
gists, pathologists,  and  bacteriologists — as  the  subject  has  an  important  bearing 
upon  each  one  of  their  spheres.     The  author's  conclusions  are  based  on  reports 
of  over  1700  cases,  including  practically  all  those  recorded  in  the  last  fifty  years. 
Reports  of  cases  have  been  brought  down  to  date,  many  having  been  added 
while  the  work  was  in  press. 

"  This  is  probably  the  first  and  only  work  in  the  English  language  that  gives  the  reader  a 
clear  view  of  what  typhoid  fever  really  is,  and  what  it  does  and  can  do  to  the  human  organ- 
ism. This  book  should  be  in  the  possession  of  every  medical  man  in  America." — American 
Medico-Surgical  Bulletin. 


CATALOGUE    OF  MEDICAL    WORKS.  19 

MODERN  SURGERY,  GENERAL  AND  OPERATIVE.  By  JOHN 
CHALMERS  D.\COSTA,  M.D.,  Clinical  Professor  of  Surgery,  Jefferson  Medi- 
cal College,  Philadelphia;  Surgeon  to  the  Philadelphia  Hospital,  etc. 
Handsome  octavo  volume  of  911  pages,  profusely  illustrated.  Cloth,  $4.00 
net ;  Half- Morocco,  $5.00  net. 

Second  Edition,  Rewritten  and  Greatly  Enlarged. 

The  remarkable  success  attending  DaCosta's  Manual  of  Surgery,  and  the 
general  favor  with  which  it  has  been  received,  have  led  the  author  in  this 
revision  to  produce  a  complete  treatise  on  modern  surgery  along  the  same  lines 
that  made  the  former  edition  so  successful.  The  book  has  been  entirely  re- 
written and  very  much  enlarged.  The  old  edition  has  long  been  a  favorite  not 
only  with  students  and  teachers,  but  also  with  practising  physicians  and  sur- 
geons, and  it  is  believed  that  the  present  work  will  find  an  even  wider  field  of 
usefulness. 

"  We  know  of  no  small  work  on  surgery  in  the  English  language  which  so  well  fulfils  the 
requirements  of  the  modern  student." — Medico-Chirurgical  Journal,  Bristol,  England. 

"The  author  has  presented  concisely  and  accurately  the  principles  of  modern  surgery. 
The  book  is  a  valuable  one  which  can  be  recommended  to  students  and  is  of  great  value  to 
the  general  practitioner." — American  Journal  of  the  Medical  Sciences. 

A  MANUAL  OF  ORTHOPEDIC  SURGERY.  By  JAMES  E.  MOORE, 
M.D.,  Professor  of  Orthopedics  and  Adjunct  Professor  of  Clinical  Surgery, 
University  of  Minnesota,  College  of  Medicine  and  Surgeiy.  Octavo  volume 
of  356  pages,  with  177  beautiful  illustrations  from  photographs  made  spec- 
ially for  this  work.  Cloth,  $2.50  net. 

A  practical  book  based  upon  the  author's  experience,  in  which  special  stress 
is  laid  upon  early  diagnosis  and  treatment  such  as  can  be  carried  out  by  the 
general  practitioner.  The  teachings  of  the  author  are  in  accordance  with  his 
belief  that  true  conservatism  is  to  be  found  in  the  middle  course  between  the 
surgeon  who  operates  too  frequently  and  the  orthopedist  who  seldom  operates. 

"A  very  demonstrative  work,  every  illustration  of  which  conveys  a  lesson.  The  work  is 
a  most  excellent  and  commendable  one,  which  we  can  certainly  endorse  with  pleasure." — 
St.  Louis  Medical  and  Surgical  yournal. 

ELEMENTARY   BANDAGING    AND    SURGICAL    DRESSING. 

With  Directions  concerning  the  Immediate  Treatment  of  Cases  of  Emer- 
gency. For  the  use  of  Dressers  and  Nurses.  By  WALTER  PYE,  F.R.C.S., 
late  Surgeon  to  St.  Mary's  Hospital,  London.  Small  I2mo,  with  over  80 
illustrations.  Cloth,  flexible  covers,  75  cents  net. 

This  little  book  is  chiefly  a  condensation  of  those  portions  of  Pye's  "  Surgical 
Handicraft "  which  deal  with  bandaging,  splinting,  etc.,  and  of  those  which 
treat  of  the  management  in  the  first  instance  of  cases  of  emergency.  The 
directions  given  are  thoroughly  practical,  and  the  book  will  prove  extremely  use- 
ful to  students,  surgical  nurses,  and  dressers. 

"  The  author  writes  well,  the  diagrams  are  clear,  and  the  book  itself  is  small  and  portable, 
although  the  paper  and  type  are  good." — British  Medical  Journal. 


20  W.   B.   SAUNDERS' 


A  TEXT-BOOK  OF  MATERIA  MEDICA,  THERAPEUTICS 
AND  PHARMACOLOGY.  By  GEORGE  F.  BUTLER,  I'll.*;.,  M.D., 
Professor  of  Materia  Medica  and  of  Clinical  Medicine  in  the  College  of 
Physicians  and  Surgeons,  Chicago;  Professor  of  Materia  Medica  and 
Therapeutics,  Northwestern  University,  Woman's  Medical  School,  etc. 
Octavo,  860  pages,  illustrated.  Cloth,  $4.00  net ;  Sheep,  55.00  net. 

Third    Edition,  Thoroitt/hh/  lievised. 

A  clear,  concise,  and  practical  text-book,  adapted  for  permanent  reference  no 
less  than  for  the  requirements  of  the  class-room. 

The  recent  important  additions  made  to  our  knowledge  of  the  physiological 
action  of  drugs  are  fully  discussed  in  the  present  edition.  Many  alterations  also 
have  been  made  in  the  chapters  on  Diuretics  and  Cathartics. 

"  Taken  as  a  whole,  the  book  may  fairly  be  considered  as  one  of  the  most  satisfactory  of  any 
single-volume  works  on  materia  medica  in  the  market."— Journal  i>f  the  American  Medical 
Association. 

TUBERCULOSIS  OF  THE  GENITO-URINARY  ORGANS, 
MALE  AND  FEMALE.  By  NICHOLAS  SENN,  M.I).,  Pii.I).,  I.L.D., 
Professor  of  the  Practice  of  Surgery  and  of  Clinical  Surgery,  Rush  Medical 
College,  Chicago.  Handsome  octavo  volume  of  320  pages,  illustrated^ 
Cloth,  $3.00  net. 

Tuberculosis  of  the  male  and  female  genito-urinary  organs  is  such  a  frequent, 
distressing,  and  fatal  affection  that  a  special  treatise  on  the  subject  appears  to 
fill  a  gap  in  medical  literature.  In  the  present  work  the  bacteriology  of  the  sub- 
ject has  received  due  attention,  the  modern  resources  employed  in  the  differen- 
tial diagnosis  between  tubercular  and  other  inflammatory  affections  are  fully 
described,  and  the  medical  and  surgical  therapeutics,  are  discussed  in  detail. 

"An  important  book  upon  an  important  subject,  and  written  by  a  man  of  mature  judg- 
ment and  wide  experience.  The  author  has  given  us  an  instructive  book  upon  one  of  the 
most  important  subjects  of  the  day." — Clinical  Reporter. 

"  A  work  which  adds  another  to  the  many  obligations  the  profession  owes  the  talented 
author."—  Chicago  Medical  Recorder. 

A  TEXT-BOOK  OF  DISEASES  OF  WOMEN.  By  CHARLES  B. 
PENROSE,  M.D.,  PH.D.,  Professor  of  Gynecology  in  the  University  of 
Pennsylvania;  Surgeon  to  the  Gynecean  Hospital,  Philadelphia.  Octavo 
volume  of  529  pages,  with  217  illustrations,  nearly  all  from  drawings  made 
for  this  work.  Cloth,  $3.50  net. 

Second  Edition,  lievised. 

In  this  work,  which  has  been  written  for  both  the  student  of  gynecology  and 
the  general  practitioner,  the  author  presents  the  best  teaching  of  modern  gyne- 
cology untrammelled  by  antiquated  theories  or  methods  of  treatment.  In  most 
instances  but  one  plan  of  treatment  is  recommended,  to  avoid  confusing  the 
student  or  the  physician  who  consults  the  book  for  practical  guidance. 

"  I  shall  value  very  highly  the  copy  of  Penrose's  '  Diseases  of  Women '  received.  1  have 
already  recommended  it  to  my  class  as  THE  BEST  book."— HOWARD  A.  KELLY,  Professor 
of  Gynecology  and  Obstetrics,  Johns  Hopkins  University,  Baltimore,  Mi/. 

"  The  book  is  to  be  commended  without  reserve,  not  only  to  the  student  but  to  the  general 
practitioner  who  wishes  to  have  the  latest  and  best  modes  of  treatment  explained  with  absolute 
clearness."—  Therapeutic  Gazette. 


CATALOGUE    OF  MEDICAL    WORKS.  21 


SURGICAL  PATHOLOGY  AND  THERAPEUTICS.  By  JOHN 
COLLINS  WARREN,  M.  D.,  LL.D.,  Professor  of  Surgery,  Medical  Depart- 
ment Harvard  University;  Surgeon  to  the  Massachusetts  General  Hospital, 
etc.  A  handsome  octavo  volume  of  832  pages,  with  136  relief  and  litho- 
graphic illustrations,  33  of  which  are  printed  in  colors,  and  all  of  which 
were  drawn  by  William  J.  Kaula  from  original  specimens.  Prices :  Cloth, 
$6.00  net;  Half-Morocco,  $7.00  net. 

Without   Exception,  the  Illustrations   are   the  Best  ever  Seen   in   a 
Work  of  this  Kind. 

"A  most  striking  and  very  excellent  feature  of  this  book  is  its  illustrations.  Without  ex- 
ception, from  the  point  of  accuracy  and  artistic  merit,  they  are  the  best  ever  seen  in  a  work 
of  this  kind.  *  *  *  Many  of  those  representing  microscopic  pictures  are  so  perfect  in  their 
coloring  and  detail  as  almost  to  give  the  beholder  the  impression  that  he  is  looking  down  the 
barrel  of  a  microscope  at  a  well-mounted  section." — Annals  of  Surgery,  Philadelphia. 

"  It  is  the  handsomest  specimen  of  book-making  *  *  *  that  has  ever  been  issued  from  the 
American  medical  press." — American  Journal  q/  the  Medical  Sciences,  Philadelphia. 

PATHOLOGY  AND  SURGICAL  TREATMENT  OF  TUMORS. 
By  N.  SENN,  M.  D.,  Ph.  D.,  LL.  D.,  Professor  of  Practice  of  Surgery  and 
of  Clinical  Surgery,  Rush  Medical  College;  Professor  of  Surgery,  Chicago 
Polyclinic;  Attending  Surgeon  to  Presbyterian  Hospital;  Surgeon-in-Chief, 
St.  Joseph's  Hospital,  Chicago.  One  volume  of  710  pages,  with  515 
engravings,  including  full-page  colored  plates.  Prices :  Cloth,  £6.00  net ; 
Half-Morocco,  $7.00  n.et. 

Books  specially  devoted  to  this  subject  are  few,  and  in  our  text-books  and 
systems  of  surgery  this  part  of  surgical  pathology  is  usually  condensed  to  a  de- 
gree incompatible  with  its  scientific  and  clinical  importance.  The  author  spent 
many  years  in  collecting  the  material  for  this  work,  and  hns  taken  great  pains 
to  present  it  in  a  manner  that  should  prove  useful  as  a  text-book  for  the  student, 
a  work  of  reference  for  the  practitioner,  and  a  reliable  guide  for  the  surgeon. 

"  The  most  exhaustive  of  any  recent  book  in  English  on  this  subject.  It  is  well  illus- 
trated, and  will  doubtless  remain  as  the  principal  monograph  on  the  subject  in  our  language 
for  some  years.  The  book  is  handsomely  illustrated  and  printed,  ....  and  the  author  has 
given  a  notable  and  lasting  contribution  to  surgery." — Journal  ef  the  American  Medical 
Association,  Chicago. 

LECTURES    ON    RENAL    AND    URINARY     DISEASES.      By 

ROBERT  SAUNDBY,  M.  D.,  Edin.,  Fellow  of  the  Royal  College  of  Physicians, 
London,  and  of  the  Royal  Medico-Chirurgical  Society ;  Physician  to  the 
General  Hospital.  Octavo  volume  of  434  pages,  with  numerous  illustra- 
tions and  4  colored  plates.  Cloth,  $2.50  net. 

"  The  volume  makes  a  favorable  impression  at  once.  The  style  is  clear  and  succinct. 
We  cannot  find  any  part  of  the  subject  in  which  the  views  expressed  are  not  carefully  thought 
out  and  fortified  by  evidence  drawn  from  the  most  recent  sources.  The  book  may  be  cordially 
recommended." — British  Medical  Journal. 

"  The  work  represents  the  present  knowledge  of  renal  and  urinary  diseases.  It  is  ad- 
mirably written  and  is  accurately  scientific." — Medical  News. 


22  W.  B.   SAUNDERS' 


A  NEW  PRONOUNCING  DICTIONARY  OF  MEDICINE,  with 
Phonetic  Pronunciation,  Accentuation,  Etymology,  etc.  By  JOHN 
M.  KEATING,  M.  D.,  LL.D.,  Fellow  of  the  College  of  Physicians  of  Phila- 
delphia; Vice- President  of  the  American  Pxdiatric  Society;  Ex-President 
of  the  Association  of  Life  Insurance  Medical  Directors;  Editor  "  Cyclo- 
paedia of  the  Diseases  of  Children,"  etc. ;  and  HENRY  HAMILTON,  author 
of  "  A  New  Translation  of  Virgil's  ^Eneid  into  English  Rhyme ;"  co- 
author of  "  Saunders'  Medical  Lexicon,"  etc. ;  with  the  Collaboration  of 
J.  CHALMERS  DACOSTA,  M.  D.,  and  FREDERICK  A.  PACKARD,  M.  D. 
With  an  Appendix  containing  important  Tables  of  Bacilli,  Micrococci, 
Leucomalnes,  Ptomaines,  Drugs  and  Materials  used  in  Antiseptic  Sur- 
gery, Poisons  and  their  Antidotes,  Weights  and  Measures,  Thermometric 
Scales,  New  Official  and  Unofficial  Drugs,  etc.  One  very  attractive  volume 
of  over  800  pages.  Second  Revised  Edition.  Prices  :  Cloth,  $5.00  net ; 
Sheep  or  Half-Morocco,  $6.00  net;  with  Denison's  Patent  Ready- Refer- 
ence Index ;  without  patent  index,  Cloth,  $4.00  net ;  Sheep  or  Half- 
Morocco,  $5.00  net. 

PROFESSIONAL  OPINIONS. 

"  I  am  much  pleased  with  Keating's  Dictionary,  and  shall  take  pleasure  in  recommending 
it  to  my  classes." 

HENKV  M.  LYMAN,  M.  D., 
Professor  of  Principles  and  Practice  of  Medicine,  Rusk  Medical  College,  Chicago,  III. 

"  I  am  convinced  that  it  will  be  a  very  valuable  adjunct  to  my  study-table,  convenient  in 
size  and  sufficiently  full  for  ordinary  use." 

C.  A.  LlNDSLKY,  M.  D., 

Professor  of  Theory  and  Practice  of  Medicine,  Medical  Dept.  Yale  University : 

Secretary  Connecticut  State  Board  of  Health,  Neiv  Haven,  Conn, 


AUTOBIOGRAPHY  OF  SAMUEL  D.  GROSS,  M.  D.,  Emeritus  Pro- 
fessor of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia,  with 
Reminiscences  of  His  Times  and  Contemporaries.      Edited  by  his  sons, 
SAMUEL  W.  GROSS,  M.  D.,  LL.D.,  late  Professor  of  Principles  of  Surgery 
and  of  Clinical  Surgery  in  the  Jefferson  Medical  College,  and  A.  HALLER 
GROSS,  A.  M.,  of  the  Philadelphia  Bar.     Preceded  by  a  Memoir  of  Dr. 
Gross,  by  the  late  Austin  Flint,  M.  D.,  LL.D.     In  two  handsome  volumes, 
each  containing  over  400  pages,  demy  8vo,  extra  cloth,  gilt  tops,  with  fine 
Frontispiece  engraved  on  steel.    Price  per  Volume,  $2.50  net 
T  his  autobiography,  which  was  continued  by  the  late  eminent  surgeon  until 
within  three  months  of  his  death,  contains  a  full   and  accurate  history  of  his 
early  struggles,  trials,  and  subsequent  successes,  told  in  a  singularly  interesting 
and  charming  manner,  and  embraces  short  and  graphic  pen-portraits  of  many 
of  the  most  distinguished  men — surgeons,  physicians,  divines,  lawyers,  states- 
men, scientists,  etc. — with  whom  he  was  brought  in  contact  in  America  and  in 
Europe ;  the  whole  forming  a  retrospect  of  more  than  three-quarters  of  a  century. 


CATALOGUE    OF  MEDICAL    WORKS.  2$ 

PRACTICAL  POINTS  IN  NURSING.  For  Nurses  in  Private 
Practice.  By  EMILY  A.  M.  STONEY,  Graduate  of  the  Training-School 
for  Nurses,  Lawrence,  Mass. ;  .Superintendent  of  the  Training-School  for 
Nurses,  Carney  Hospital,  South  Boston,  Mass.  456  pages,  handsomely 
illustrated  with  73  engravings  in  the  text,  and  9  colored  and  half-tone 
plates.  Cloth.  Price,  #1.75  net. 

SECOND  EDITION,  THOROUGHLY  REVISED. 

In  this  volume  the  author  explains,  in  popular  language  and  in  the  shortest 
possible  form,  the  entire  range  of  priv ate  nursing  as  distinguished  from  hospital 
nursing,  and  the  nurse  is  instructed  how  best  to  meet  the  various  emergencies  of 
medical  and  surgical  cases  when  distant  from  medical  or  surgical  aid  or  when 
thrown  on  her  own  resources. 

An  especially  valuable  feature  of  the  work  will  be  found  in  the  directions  to 
the  nurse  how  to  improvise  everything  ordinarily  needed  in  the  sick-room,  where 
the  embarrassment  of  the  nurse,  owing  to  the  want  of  proper  appliances,  is  fre- 
quently extreme. 

The  work  has  been  logically  divided  into  the  following  sections : 

I.  The  Nurse  :  her  responsibilities,  qualifications,  equipment,  etc. 
II.  The  Sick- Room  :  its  selection,  preparation,  and  management. 

III.  The  Patient :  duties  of  the  nurse  in  medical,  surgical,  obstetric,  and  gyne- 

cologic cases. 

IV.  Nursing  in  Accidents  and  Emergencies. 
V.  Nursing  in  Special  Medical  Cases. 

VI.  Nursing  of  the  New-born  and  Sick  Children. 
VII.  Physiology  and  Descriptive  Anatomy. 

The  APPENDIX  contains  much  information  in  compact  form  that  will  be  found 
of  great  value  to  the  nurse,  including  Rules  for  Feeding  the  Sick;  Recipes  for 
Invalid  Foods  and  Beverages ;  Tables  of  Weights  and  Measures ;  Table  for 
Computing  the  Date  of  Lalx>r;  List  of  Abbreviations ;  Dose-List;  and  a  full 
and  complete  Glossary  of  Medical  Terms  and  Nursing  Treatment. 

"This  is  a  wall-written,  eminently  practical  volume,  which  covers  the  entire  range  of 
private  nursing  as  distinguished  from  hospital  nursing,  and  instructs  the  nurse  how  best  to 
meet  the  various  emergencies  which  may  arise  and  how  to  prepare  everything  ordinarily 
needed  in  the  illness  of  her  patient." — American  Journal  of  Obstetrics  and  Diseases  of 
Women  and  Children,  Aug.,  1896. 

A  TEXT-BOOK  OF  BACTERIOLOGY,  including  the  Etiology  and 
Prevention  of  Infective  Diseases  and  an  account  of  Yeasts  and  Moulds, 
Haematozoa,  and  Psorosperms.  By  EDGAR  M.  CROOKSHANK,  M.  B.,  Pro- 
fessor of  Comparative  Pathology  and  Bacteriology,  King's  College,  London. 
A  handsome  octavo  volume  of  700  pages,  with  273  engravings  in  the  text, 
and  22  original  and  colored  plates.  Price,  $6.50  net. 

This  book,  though  nominally  a  Fourth  Edition  of  Professor  Crookshank's 
"  MANUAL  OF  BACTERIOLOGY,"  is  practically  a  new  work,  the  old  one  having 
been  reconstructed,  greatly  enlarged,  revised  throughout,  and  largely  rewritten, 
forming  a  text-book  for  the  Bacteriological  Laboratory,  for  Medical  Ofhcers  of 
Health,  and  for  Veterinary  Inspectors. 


24  W.  B.   SAUNDERS 


MEDICAL  DIAGNOSIS.  By  Dr.  OSWALD  VIERORDT,  Professor  of 
Medicine  at  the  University  of  Heidelberg.  Translated,  with  additions, 
from  the  Fiftli  Enlarged  German  Edition,  with  the  author's  permission,  by 
FRANCIS  H.  STUART,  A.  M.,  M.  D.  In  one  handsome  royal-octavo  volume 
of  600  pages.  194  fine  wood-cuts  in  the  text,  many  of  them  in  odors. 
Prices:  Cloth,  $4.00  net;  Sheep  or  Half-Morocco,  $5.00  net. 

FOURTH  AMERICAN  EDITION,  FROM  THE  FIFTH  REVISED  AND 
ENLARGED  GERMAN  EDITION. 

In  this  work,  as  in  no  other  hitherto  published,  are  given  full  and  accurate 
explanations  of  the  phenomena  observed  at  the  bedside.  It  is  distinctly  a  clin- 
ical work  by  a  master  teacher,  characterized  by  thoroughness,  fulness,  and  accu- 
racy. It  is  a  mine  of  information  upon  the  points  that  are  so  often  passed  over 
without  explanation.  Especial  attention  has  been  given  to  the  germ-theory  as  a 
factor  in  the  origin  of  disease. 

The  present  edition  of  this  highly  successful  work  has  been  translated  from 
the  fifth  German  edition.  Many  alterations  have  been  made  throughout  the 
book,  but  especially  in  the  sections  on  Gastric  Digestion  and  the  Nervous  System. 

It  will  be  found  that  all  the  qualities  which  served  to  make  the  earlier  editions 
so  acceptable  have  been  developed  with  the  evolution  of  the  work  to  its  present 
form. 

THE  PICTORIAL  ATLAS  OF  SKIN  DISEASES  AND  SYPHI- 
LITIC AFFECTIONS.  (American  Edition.)  Translation  from 
the  French.  Edited  by  J.  J.  PRINGLE,  M.  B.,  F.  R.  C.  P.,  Assistant  Phy- 
sician to,  and  Physician  to  the  department  for  Diseases  of  the  Skin  at,  the 
Middlesex  Hospital,  London.  Photo-lithochromes  from  the  famous  models 
of  dermatological  and  syphilitic  cases  in  the  Museum  of  the  Saint-Louis 
Hospital,  Paris,  with  explanatory  wood-cuts  and  letter-press.  In  12  Parts, 
at  #3.00  per  Part. 

"Of  all  the  atlases  of  skin  diseases  which  have  heen  published  in  recent  years,  the  present 
one  promises  to  be  of  greatest  interest  and  value,  especially  from  the  standpoint  of  the 
general  practitioner." — American  Medico-Surgical  Bulletin,  Feb.  22,  1896. 

"The  introduction  of  explanatory  wood-cuts  in  the  text  is  a  novel  and  most  important 
feature  which  greatly  furthers  the  easier  understanding  of  the  excellent  plates,  than  which 
nothing,  we  venture  to  say,  has  been  seen  better  in  point  of  correctness,  beauty,  and  general 
merit." — New  York  Medical  Journal ,  Feb.  15,  1896. 

"An  interestingfeature  of  the  Atlas  is  the  descriptive  text,  which  is  written  for  each  picture 
by  the  physician  who  treated  the  case  or  at  whose  instigation  the  models  have  been  made. 
We  predict  for  this  truly  beautiful  work  a  large  circulation  in  all  parts  of  the  medical  world 
where  the  names  St.  Louis  and  Baretta  have  preceded  it." — Medical  Record,  N.  Y..  Feb.  i, 
1896. 

A  TEXT-BOOK  OF  MECHANO-THERAPY  (MASSAGE  AND 
MEDICAL  GYMNASTICS).  By  Axi.i,  V.  GRAKSTROM,  11.  Sc., 
M.  D.,  late  Lieutenant  in  the  Royal  Swedish  Army;  late  House  1'hysi- 
cian,  City  Hospital,  Blackwell's  Island,  New  York.  I2mo,  139  pages, 
illustrated.  Cloth,  $l.oo  net. 


CATALOGUE    OF  MEDICAL    WORKS.  2$ 

DISEASES  OF  THE  EYE.  A  Hand-Book  of  Ophthalmic  Prac- 
tice. By  G.  E.  DE  SCHWEINITZ,  M.  D.,  Professor  of  Ophthalmology  in 
the  Jefferson  Medical  College,  Philadelphia,  etc.  A  handsome  royal- 
octavo  volume  of  696  pages,  with  255  fine  illustrations,  many  of  which  are 
original,  and  2  chromo-lithographic  plates.  Prices :  Cloth,  $4.00  net ; 
Sheep  or  Half-Morocco,  $5.00  net. 

THIRD  EDITION,  THOROUGHLY  REVISED. 

In  the  third  edition  of  this  text-book,  destined,  it  is  hoped,  to  meet  the  favor- 
able reception  which  has  been  accorded  to  its  predecessors,  the  work  has  been 
revised  thoroughly,  and  much  new  matter  has  been  introduced.  Particular 
attention  has  been  given  to  the  important  relations  which  micro-organisms  bear 
to  many  ocular  diseases.  A  number  of  special  paragraphs  on  new  subjects  have 
been  introduced,  and  certain  articles,  including  a  portion  of  the  chapter  on 
Operations,  have  been  largely  rewritten,  or  at  least  materially  changed.  A 
number  of  new  illustrations  have  been  added.  The  Appendix  contains  a  full 
ilocription  of  the  method  of  determining  the  corneal  astigmatism  with  the 
ophthalmometer  of  Javal  and  Schiotz,  and  the  rotation  of  the  eyes  with  the 
tropometer  of  Stevens. 

"  A  work  that  will  meet  the  requirements  not  only  of  the  specialist,  but  of  the  general 
practitioner  in  a  rare  degree.  I  am  satisfied  that  unusual  success  awaits  it." 

WILLIAM  PEPPER,  M.  D. 

Provost  and  Professor  of  Theory  and  Practice  of  Medicine  and  Clinical  Medicine 
in  the  University  of  Pennsylvania. 

"A  clearly  written,  comprehensive  manual.  .  .  .  One  which  we  can  commend  to  students 
as  a  reliable  text-book,  written  with  an  evident  knowledge  of  the  wants  of  those  entering  upon 
the  study  of  this  special  branch  of  medical  science." — British  Medical  Journal. 

"  It  is  hardly  too  much  to  say  that  for  the  student  and  practitioner  beginning  the  study  of 
Ophthalmology,  it  is  the  best  single  volume  at  present  published." — Medical  Netvs . 

"  It  is  a  very  useful,  satisfactory,  and  safe  guide  for  the  student  and  the  practitioner,  and 
one  of  the  best  works  of  this  scope  in  the  English  language." — Annals  of  Ophthalmolcgy. 

DISEASES  OF  WOMEN.  By  J.  BLAND  SUTTON,  F.  R.  C.  S.,  Assistant 
Surgeon  to  Middlesex  Hospital,  and  Surgeon  to  Chelsea  Hospital,  London ; 
and  ARTHUR  E.  GILES,  M.  D.,  B.  Sc.,  Lond.,  F.  R.C.  S.,  Ed  in.,  Assistant 
Surgeon  to  Chelsea  HospitaJ,  London.  436  pages,  handsomely  illustrated. 
Cloth,  $2.50  net. 

The  authors  have  placed  in  the  hands  of  the  physician  and  student  a  concise 
yet  comprehensive  guide  to  the  study  of  gynecology  in  its  most  modern  develop- 
ment. It  has  been  their  aim  to  relate  facts  and  describe  methods  belonging  to 
the  science  and  art  of  gynecology  in  a  way  that  will  prove  useful  to  students  for 
examination  purposes,  and  which  will  also  enable  the  general  physician  to  prac- 
tice this  important  department  of  surgery  with  advantage  to  his  patients  and  with 
satisfaction  to  himself. 

"  The  book  is  very  well  prepared,  and  is  certain  to  be  well  received  by  the  medical  public." 
— British  Medical  Journal. 

"The  text  has  been  carefully  prepared.  Nothing  essential  has  been  omitted,  and  its 
teachings  are  those  recommended  by  the  leading  authorities  of  the  day."— Journal  of  the 
American  Medical  Association. 


26  W.   b.   SAUNDERS' 


TEXT-BOOK  UPON  THE  PATHOGENIC  BACTERIA.  Spe- 
cially written  for  Students  of  Medicine.  By  Josi.ru  Mr]  AK LAND, 
M.  D.,  Professor  of  Pathology  and  Bacteriology  in  the  Medico-Chirurgical 
College  of  Philadelphia,  etc.  497  pages,  finely  illustrated.  Price,  Cloth, 
$2.50  net. 

SECOND  EDITION,  REVISED  AND  GREATLY  ENLARGED. 
The  work  is  intended  to  be  a  text-book  for  the  medical  student  and  for  the 
practitioner  who  has  had  no  recent  laboratory  training  in  this  department  of  medi- 
cal science.  The  instructions  given  as  to  needed  apparatus,  cultures,  stainings, 
microscopic  examinations,  etc.  are  ample  for  the  student's  m-i-ds.  and  \\ill  atlord 
to  the  physician  much  information  that  will  interest  and  profit  him  relative  to  a 
subject  which  modern  science  shows  to  go  far  in  explaining  the  etiology  of  many 
diseased  conditions. 

In  this  second  edition  the  work  has  been  brought  up  to  date  in  all  depart- 
ments of  the  subject,  and  numerous  additions  have  been  made  to  the  technique 
in  the  endeavor  to  make  the  book  fulfil  the  double  purpose  of  a  systematic  work 
upon  bacteria  and  a  laboratory  guide. 

"  It  is  excellently  adapted  for  the  medical  students  and  practitioners  for  whom  it  is  avowedly 
written.  .  .  .  The  descriptions  given  are  accurate  and  readable,  and  the  book  should  prove 
useful  to  those  for  whom  it  is  written. — London  Lancet,  Aug.  29,  1896. 

"  The  author  has  succeded  admirably  in  presenting  the  essential  details  of  bacteriological 
technics,  together  with  a  judiciously  chosen  summary  of  our  present  knowledge  of  pathogenic 
bacteria.  .  .  .  The  work,  we  think,  should  have  a  wide  circulation  among  English-speaking 
students  of  medicine." — N.  Y.  Medical  Journal,  April  4,  1896. 

"  The  book  will  be  found  of  considerable  use  by  medical  men  who  have  not  had  a  special 
bacteriological  training,  and  who  desire  to  understand  this  important  branch  of  medical 
science." — Edinburgh  Medical  Journal,  July,  1896. 

LABORATORY    GUIDE    FOR    THE    BACTERIOLOGIST.      By 

LANGDON  FROTHINGHAM,  M.  D.  V.,  Assistant  in  Bacteriology  and  Veteri- 
nary Science,  Sheffield  Scientific  School,  Yale  University.  Illustrated. 
Price,  Cloth,  75  cents. 

The  technical  methods  involved  in  bacteria-culture,  methods  of  staining,  and 
microscopical  study  are  fully  described  and  arranged  as  simply  and  concisely  as 
possible.  The  book  is  especially  intended  for  use  in  laboratory  work 

"  It  is  a  convenient  and  useful  little  work,  and  will  more  than  repay  the  outlay  necessary 
for  its  purchase  in  the  saving  of  time  which  would  otherwise  be  consumed  in  looking  up  the 
various  points  of  technique  so  clearly  and  concisely  laid  down  in  its  pages." — American  Aled.- 
Surg.  Bulletin. 

FEEDING  IN  EARLY  INFANCY.  By  ARTHUR  V.  MEIGS,  M.  D. 
Bound  in  limp  cloth;  flush  edges.  Price,  25  cents  net. 

SYNOPSIS  :  Analyses  of  Milk — Importance  of  the  Subject  of  Feeding  in  Early 
Infancy — Proportion  of  Casein  and  Sugar  in  Human  Milk — Time  to  Begin  Arti- 
ficial Feeding  of  Infants — Amount  of  Food  to  be  Administered  at  Each  Feed- 
ing— Intervals  between  Feedings — Increase  in  Amount  of  Food  at  Different 
Periods  of  Infant  Development — Unsuitableness  of  Condensed  Milk  as  a  Sub- 
stitute for  Mother's  Milk— Objections  to  Sterilization  or  "Pasteurization"  of 
Milk — Advances  made  in  the  Method  of  Artificial  Feeding  of  Infants. 


CATALOGUE    OF  MEDICAL    WORKS.  2/ 

MATERIA  MEDICA  FOR  NURSES.  By  EMII.Y  A.  M.  STONEY, 
Graduate  of  the  Training-school  for  Nurses,  Lawrence,  Mass.  ;  late 
Superintendent  of  the  Training-school  for  Nurses,  Carney  Hospital,  South 
Boston,  Mass.  Handsome  octavo,  300  pages.  Cloth,  $1.50  net. 

The  present  book  differs  from  other  similar  works  in  several  features,  all  of 
which  are  introduced  to  render  it  more  practical  and  generally  useful.  The 
general  plan  of  contents  follows  the  lines  laid  down  in  training-schools  for 
nurses,  but  the  book  contains  much  useful  matter  not  usually  included  in  works 
of  this  character,  such  as  Poison-emergencies,  Ready  Dose-list,  \Veights  and 
Measures,  etc.,  as  well  as  a  Glossary,  defining  all  the  terms  in  Materia  Medica, 
and  describing  all  the  latest  drugs  and  remedies,  which  have  been  generally 
neglected  by  other  books  of  the  kind. 

ESSENTIALS  OF  ANATOMY  AND  MANUAL  OF  PRACTI- 
CAL DISSECTION,  containing  "  Hints  on  Dissection  "  By  CHARI  ES 
B.  NANCREDE,  M.  D.,  Professor  of  Surgery  and  Clinical  Surgery  in  the 
University  of  Michigan,  Ann  Arbor;  Corresponding  Member  of  the  Royal 
Academy  of  Medicine,  Rome,  Italy ;  late  Surgeon  Jefferson  Medical  Col- 
lege, etc.  Fourth  and  revised  edition.  lost  8vo,  over  500  pages,  with 
handsome  full-page  lithographic  plates  in  coiors,  and  over  200  illustrations. 
Price  :  Extra  Cloth  or  Oilcloth  for  the  dissection-room,  $2.00  net. 

Neither  pains  nor  expense  has  been  spared  to  make  this  work  the  most  ex- 
haustive yet  concise  Student's  Manual  of  Anatomy  and  Dissection  ever  pub- 
lished, either  in  America  or  in  Europe. 

The  colored  plates  are  designed  to  aid  the  student  in  dissecting  the  muscles 
arteries,  veins,  and  nerves.  The  wood-cuts  have  all  been  specially  drawn  and 
engraved,  and  an  Appendix  added  containing  60  illustrations  representing  the 
structure  of  the  entire  human  skeleton,  the  whole  being  based  on  the  eleventh 
edition  of  Gray's  Anatomy. 

A  MANUAL  OF  PRACTICE  OF  MEDICINE.  By  A.  A.  STEVENS, 
A.  M.,  M.  D.,  Instructor  in  Physical  Diagnosis  in  the  University  of  Penn- 
sylvania, and  Professor  of  Pathology  in  the  Woman's  Medical  College  of 
Pennsylvania.  Specially  intended  for  students  preparing  for  graduation 
and  hospital  examinations.  Post  8vo,  519  pages.  Numerous  illustrations 
and  selected  formulce.  Price,  bound  in  flexible  leather,  $2.00  net. 

FIFTH  EDITION,  REVISED  AND  ENLARGED. 

Contributions  to  the  science  of  medicine  have  poured  in  so  rapidly  during  the 
last  quarter  of  a  century  that  it  is  well-nigh  impossible  for  the  student,  with  the 
limited  time  at  his  disposal,  to  master  elaborate  treatises  or  to  cull  from  them 
that  knowledge  which  is  absolutely  essential.  From  an  extended  experience  in 
teaching,  the  author  has  been  enabled,  by  classification,  to  group  allied  symp- 
toms, and  by  the  judicious  elimination  of  theories  and  redundant  explanations 
to  bring  within  a  comparatively  small  compass  a  complete  outline  of  the  prac- 
tice of  medicine. 


28  W.   B.   SAUNDERS 


MANUAL    OF    MATERIA    MEDICA    AND    THERAPEUTICS. 

By  A.  A.  STEVENS,  A.  M.,  M.  D.,  Instructor  of  Physical  Diagnosis  in  the 
University  of  Pennsylvania,  and  Professor  of  Pathology  in  the  Woman's 
Medical  College  of  Pennsylvania.  445  pages.  Price,  bound  in  flexible 
leather,  $2.25. 

SECOND   EDITION,    REVISED. 

This  wholly  new  volume,  which  is  based  on  the  last  edition  of  the  Pharma- 
copoeia, comprehends  the  following  sections :  Physiological  Action  of  Drugs ; 
Drugs;  Remedial  Measures  other  than  Drugs;  Applied  Therapeutics  ;.  Incom- 
patibility in  Prescriptions;  Table  of  Doses;  Index  of  Drugs;  and  Index  of 
Diseases ;  the  treatment  being  elucidated  by  more  than  two  hundred  formulae. 

"  The  author  is  to  be  congratulated  upon  having  presented  the  medical  student  with  as 
accurate  a  manual  of  therapeutics  as  it  is  possible  to  prepare."—  Therapeutic  Gazette. 

"  Far  superior  to  most  of  its  class  ;  in  fact,  it  is  very  good.  Moreover,  the  book  is  reliable 
and  accurate." — New  York  Medical  Journal. 

"The  author  has  faithfully  presented  modern  therapeutics  in  a  comprehensive  work,  .  .  . 
and  it  will  be  found  a  reliable  guide."—  University  Medical  Magazine. 

NOTES  ON  THE  NEWER  REMEDIES:  their  Therapeutic  Ap 
plications  and  Modes  of  Administration.  By  DAVID  CERNA,  M.  D., 
PH.  D.,  Demonstrator  of  and  Lecturer  on  Experimental  Therapeutics  in 
the  University  of  Pennsylvania.  Post-octavo,  253  pages.  Price,  $1.25. 

SECOND  EDITION,  RE-WRITTEN  AND  GREATLY   ENLARGED. 

The  work  takes  up  in  alphabetical  order  all  the  newer  remedies,  giving  their 
physical  properties,  solubility,  therapeutic  applications,  administration,  and 
chemical  formula. 

It  thus  forms  a  very  valuable  addition  to  the  various  works  on  therapeutics 
now  in  existence. 

Chemists  are  so  multiplying  compounds,  that,  if  each  compound  is  to  be  thor- 
oughly studied,  investigations  must  be  carried  far  enough  to  determine  the  prac- 
tical importance  of  the  new  agents. 

"  Especially  valuable  because  of  its  completeness,  its  accuracy,  its  systematic  consider- 
ation of  the  properties  and  therapy  of  many  remedies  of  which  doctors  generally  know  but 
little,  expressed  in  a  brief  yet  terse  manner." — Chicago  Clinical  Review. 

TEMPERATURE  CHART.  Prepared  by  D.  T.  LAINE,  M.  D.  Size 
8x  13^  inches.  Price,  per  pad  of  25  charts,  50  cents. 

A  conveniently  arranged  chart  for  recording  Temperature,  with  columns  for 
daily  amounts  of  Urinary  and  Fecal  Excretions,  Food,  Remarks,  etc.  On  the 
back  of  each  chart  is  given  in  full  the  method  of  Brand  in  the  treatment  of 
Typhoid  Fever. 


CATALOGUE    OF  MEDICAL    WORKS.  2Q 

A  TEXT-BOOK  OF  HISTOLOGY,  DESCRIPTIVE  AND  PRAC- 
TICAL. For  the  Use  of  Students.  By  ARTHUR  CLARKSON,  M.  B., 
C.  M.,  Edin.,  formerly  Demonstrator  of  Physiology  in  the  Owen's  College, 
Manchester;  late  Demonstrator  of  Physiology  in  the  Yorkshire  College, 
Leeds.  Large  8vo,  554  pages,  with  22  engravings  in  the  text,  and  174 
beautifully  colored  original  illustrations.  Price,  strongly  bound  in  Cloth, 
$6.00  net. 

The  purpose  of  the  writer  in  this  work  has  been  to  furnish  the  student  of  His- 
tology, in  one  volume,  with  both  the  descriptive  and  the  practical  part  of  the 
science.  The  first  two  chapters  are  devoted  to  the  consideration  of  the  general 
methods  of  Histology ;  subsequently,  in  each  chapter,  the  structure  of  the  tissue 
or  organ  is  first  systematically  described,  the  student  is  then  taken  tutorially  over 
the  specimens  illustrating  it,  and,  finally,  an  appendix  affords  a  short  note  of  the 
methods  of  preparation. 

"  The  work  must  be  considered  a  valuable  addition  to  the  list  of  available  text-books,  and 
is  to  be  highly  recommended." — New  York  Medical  Journal. 

"  One  of  the  best  works  for  students  we  have  ever  noticed.  We  predict  that  the  book  will 
attain  a  well-deserved  popularity  among  our  students." — Chicago  Medical  Recorder. 


THE  PATHOLOGY  AND  TREATMENT  OF  SEXUAL  IM- 
POTENCE. By  VICTOR  G.  VECKI,  M.  D.  From  the  second  Ger- 
man edition,  revised  and  rewritten.  Demi-octavo,  about  300  pages. 
Cloth,  $2.00  net. 

The  subject  of  impotence  has  but  seldom  been  treated  in  this  country  in  the 
truly  scientific  spirit  that  it  deserves,  and  this  volume  will  come  to  many  as  a 
revelation  of  the  possibilities  of  therapeusis  in  this  important  field.  Dr.  Vecki's 
work  has  long  been  favorably  known,  and  the  German  book  has  received  the 
highest  consideration.  This  edition  is  more  than  a  mere  translation,  for,  although 
based  on  the  German  edition,  it  has  been  entirely  rewritten  by  the  author  in 
English. 

"  The  work  can  be  recommended  as  a  scholarly  treatise  on  its  subject,  and  it  can  be  read 
with  advantage  by  many  practitioners."— Journal  of  the  American  Medical  Association. 

ARCHIVES  OF  CLINICAL  SKIAGRAPHY.  By  SYDNEY  ROWLAND, 
B.  A.,  Camb.  A  series  of  collotype  illustrations,  with  descriptive  text, 
illustrating  the  applications  of  the  New  Photography  to  Medicine  and  Sur- 
gery. Price,  per  Part,  $1.00.  Parts  I.  to  V.  now  ready. 

The  object  of  this  publication  is  to  put  on  record  in  permanent  form  some  of 
the  most  striking  applications  of  the  new  photography  to  the  needs  of  Medicine 
and  Surgery. 

The  progress  of  this  new  art  has  been  so  rapid  that,  although  Prof.  Rontgen's 
discovery  is  only  a  thing  of  yesterday,  it  has  already  taken  its  place  among  the 
approved  and  accepted  aids  to  diagnosis. 


30  W.   B.   SAUNDEKS' 


DISEASES  OF  WOMEN.  By  HENRY  J.  GARRIGUKS,  A.M.,  M.D., 
Professor  of  Gynecology  in  the  New  York  School  of  Clinical  Medicine ; 
(lyiH-i-olu^t  to  St.  Murk's  Hospital  and  to  the  German  Dispensary,  New 
York  City.  In  one  handsome  octavo  volume  of  728  pages,  illustrated  by 
335  engravings  and  colored  plates.  Prices:  Cloth,  $4.00  net;  Sheep  or 
Half- Morocco,  $5.00  net. 

A  PRACTICAL  work  on  gynecology  for  the  use  of  students  and  practitioners, 
written  in  a  terse  and  concise  manner.  The  importance  of  a  thorough  know- 
ledge of  the  anatomy  of  the  female  pelvic  organs  has  been  fully  recognized  by 
the  author,  and  considerable  space  has  been  devoted  to  the  subject.  The  chap- 
ters on  Operations  and  on  Treatment  are  thoroughly  modern,  and  are  based 
upon  the  large  hospital  and  private  practice  of  the  author.  The  text  is  eluci- 
dated by  a  large  number  of  illustrations  and  colored  plates,  many  of  them  being 
original,  and  forming  a  complete  atlas  for  studying  embryology  and  the  anatomy 
of  \.\\e  female  genitalia,  besides  exemplifying,  whenever  needed,  morbid  condi- 
tions, instruments,  apparatus,  and  operations. 

Second  Edition,  Thoroughly  Revised. 

The  first  edition  of  this  work  met  with  a  most  appreciative  reception  by  the 
medical  press  and  profession  both  in  this  country  and  abroad,  and  was  adopted 
as  a  text-book  or  recommended  as  a  book  of  reference  by  nearly  one  hundred 
colleges  in  the  United  States  and  Canada.  The  author  has  availed  himself  of 
the  opportunity  afforded  by  this  revision  to  embody  the  latest  approved  advances 
in  the  treatment  employed  in  this  important  branch  of  Medicine.  He  has  also 
more  extensively  expressed  his  own  opinion  on  the  comparative  value  of  the 
different  methods  of  treatment  employed. 

"  One  of  the  best  text-books  for  students  and  practitioners  which  has  been  published  in 
the  English  language;  it  is  condensed,  clear,  and  comprehensive.  The  profound  learning 
and  great  clinical  experience  of  the  distinguished  author  find  expression  in  this  book  in  a 
most  attractive  and  instructive  form.  Young  practitioners,  to  whom  experienced  consultants 
may  not  be  available,  will  find  in  this  book  invaluable  counsel  and  help." 

THAD.  A.  REAMY,  M.  D.,  LL.D., 

Professor  of  Clinical  Gynecology,  Medical  College  of  Ohio  :   Gynecologist  to  the  Good 
Samaritan  and  Cincinnati  Hospitals. 


A  SYLLABUS  OF  GYNECOLOGY,  arranged  in  conformity  with 
"An  American  Text-Book  of  Gynecology."  By  J.  W.  LONG,  M.  D., 
Professor  of  Diseases  of  Women  and  Children,  Medical  College  of  Vir- 
ginia, etc.  Price,  Cloth  (interleaved),  jgi.oo  net. 

Based  upon  the  teaching  and  methods  laid  down  in  the  larger  work,  this  will 
not  only  be  useful  as  a  supplementary  volume,  but  to  those  who  do  not  already 
possess  the  text-book  it  will  also  have  an  independent  value  as  an  aid  to  the 
practitioner  in  gynecological  work,  and  to  the  student  as  a  guide  in  the  lecture- 
room,  as  the  subject  ia  presented  in  a  manner  at  once  systematic,  clear,  succinct, 
pnd  practical. 


CATALOGUE    OF  MEDICAL    WORKS.  31 

THE  AMERICAN  POCKET  MEDICAL  DICTIONARY.  Edited 
by  \V.  A.  NKWMAN  BORLAND,  M.  D.,  Assistant  Obstetrician  to  the  Hospital 
of  the  University  of  Pennsylvania ;  Fellow  of  the  American  Academy  of 
Mwdicine.  Containing  the  pronunciation  and  definition  of  over  26,00x3 
words  used  in  medicine  and  the  kindred  sciences,  with  64  extensive  tables. 
Handsomely  bound  in  flexible  leather,  limp,  with  gold  edges  and  patent 
thumb  index.  Price,  $1.25  net. 

SECOND  EDITION,  REVISED. 

Oi-cr  2G,OOO   Words,  64   Valuable  Tables. 

This  is  the  ideal  pocket  lexicon.  It  is  an  absolutely  new  book,  and  not  a  re- 
vision of  any  old  work.  It  is  complete,  defining  all  the  terms  of  modern  medi- 
cine and  forming  a  vocabulary  of  over  26,000  words.  It  gives  the  pronunciation 
of  all  the  terms.  It  makes  a  special  feature  of  the  newer  words  neglected  by 
other  dictionaries.  It  contains  a  wealth  of  anatomical  tables  of  special  value  to 
student*.  It  forms  a  handy  volume,  indispensable  to  every  medical  man. 

SAUNDERS'  POCKET  MEDICAL  FORMULARY.  By  WILLIAM 
M.  POWELL,  M.  D.,  Attending  Physician  to  the  Mercer  House  for  Invalid 
Women  at  Atlantic  City.  Containing  1800  Formulae,  selected  from  several 
hundred  of  the  best  known  authorities.  Forming  a  handsome  and  con- 
venient pocket  companion  of  nearly  300  printed  pages,  with  blank  leaves 
for  Additions;  with  an  Appendix  containing  Posological  Table,  Formulae 
and  Doses  for  Hypodermatic  Medication,  Poisons  and  their  Antidotes, 
Diameters  of  the  Female  Pelvis  and  Fcetal  Head,  Obstetrical  Table,  Diet 
List  for  Various  Diseases,  Materials  and  Drugs  used  in  Antiseptic  Surgery, 
Treatment  of  Asphyxia  from  Drowning,  Surgical  Remembrancer,  Tables 
of  Incompatibles,  Eruptive  Fevers,  Weights  and  Measures,  etc.  Hand- 
somely bound  in  morocco,  with  side  index,  wallet,  and  flap.  Price,  $1.75 
net. 

FIFTH  EDITION,  THOROUGHLY  REVISED. 

"This  little  book,  that  can  be  conveniently  carried  in  the  pocket,  contains  an  immense 
amount  of  material.  It  is  very  useful,  and  as  the  name  of  the  author  of  each  prescription  is 
given, is  unusually  reliable." — New  York  Medical  Record. 

A  COMPENDIUM  OF  INSANITY.  By  JOHN  B.  CHAPIN,  M.D.,  LL.D., 
Physician-in-Chief,  Pennsylvania  Hospital  for  the  Insane;  late  Physician- 
Superintendent  ofthe  Willard  State  Hospital,  New  York  ;  Honorary  Mem- 
ber of  the  Medico- Psychological  Society  of  Great  Britain,  of  the  Society  of 
Mental  Medicine  of  Belgium.  I2mo,  234  pages,  illust.  Cloth,  $1.25  net. 

The  author  has  given,  in  a  condensed  and  concise  form,  a  compendium  of 
Diseases  of  the  Mind,  for  the  convenient  use  and  aid  of  physicians  and  students. 
It  contains  a  clear,  concise  statement  of  the  clinical  aspects  of  the  various  ab- 
normal mental  conditions,  with  directions  as  to  the  most  approved  methods  of 
managing  and  treating  the  insane. 

"  The  practical  parts  of  Dr.  Chapin's  book  are  what  constitute  its  distinctive  merit.  We 
desire  especially,  however,  to  call  attention  to  the  fact  that  in  the  subject  ofthe  therapeutics 
of  insanity  the  work  is  exceedingly  valuable.  The  author  has  made  a  distinct  addition  to  the 
literature  of  his  specialty."— Philadelphia  Medical  Journal. 


32  W.   B.    SAUNDERS' 


AN  OPERATION  BLANK,  with  Lists  of  Instruments,  etc.  re- 
quired in  Various  Operations.  Prepared  by  W.  W.  KEEN,  M.  D., 
LL.D.,  Professor  of  Principles  of  Surgery  in  the  Jefferson  Medical  Col- 
lege, Philadelphia.  Price  per  Pad,  containing  Blanks  for  fifty  operations, 
50  cents  net. 

SECOND  EDITION,  REVISED  FOKM. 

A  convenient  blank,  suitable  for  all  operations,  giving  complete  instructions 
regarding  necessary  preparation  of  patient,  etc.,  with  a  full  list  of  dressings  and 
medicines  to  be  employed. 

On  the  back  of  each  blank  is  a  list  of  instruments  used — viz.  general  instru 
ments,  etc.,  required  for  all  operations ;  and  special  instruments  for  surgery  of 
the  brain  and  spine,  mouth  and  throat,  abdomen,  rectum,  male  and  female 
genito-urinary  organs,  the  bones,  etc. 

The  whole  forming  a  neat  pad,  arranged  for  hanging  on  the  wall  of  a  sur- 
geon's office  or  in  the  hospital  operating-room. 

"Will  serve  a  useful  purpose  for  the  surgeon  in  reminding  him  of  the  details  of  prepa- 
ration for  the  patient  and  the  room  as  well  as  for  the  instruments,  dressings,  and  antiseptics 
needed" — New  York  Medical  Record 

"  Covers  about  all  that  can  be  needed  in  any  operation." — American  Lancet, 
"  The  plan  is  a  capital  one." — Boston  Medical  and  Surgical  Journal. 

LABORATORY  EXERCISES  IN  BOTANY.  By  EDSON  S.  BASTIN, 
M.  A.,  Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  Col- 
lege of  Pharmacy.  Octavo  volume  of  536  pages,  87  full-page  plates.  Price, 
Cloth,  $2.50. 

This  work  is  intended  for  the  beginner  and  the  advanced  student,  and  it  fully 
covers  the  structure  of  flowering  plants,  roots,  ordinary  stems,  rhizomes,  tubers, 
bulbs,  leaves,  flowers,  fruits,  and  seeds.  Particular  attention  is  given  to  the  gross 
and  microscopical  structure  of  plants,  and  to  those  used  in  medicine.  Illustra- 
tions have  freely  been  used  to  elucidate  the  text,  and  a  complete  index  to  facil- 
itate reference  has  been  added. 

"  There  is  no  work  like  it  in  the  pharmaceutical  or  botanical  literature  of  this  country,  and 
we  predict  for  it  a  wide  circulation." — American  Journal  of  Tharmacy. 

DIET  IN  SICKNESS  AND  IN  HEALTH.     By  MRS.  ERNEST  HART, 

formerly  Student  of  the  Faculty  of  Medicine  of  Paris  and  of  the  London 
School  of  Medicine  for  Women ;  with  an  INTRODUCTION  by  Sir  Henry 
Thompson,  F.  R.  C.  S.,  M.  D.,  London.  220  pages ;  illustrated.  Price, 
Cloth,  #1.50. 

Useful  to  those  who  have  to  nurse,  feed,  and  prescribe  for  the  sick.  In 
each  case  the  accepted  causation  of  the  disease  and  the  reasons  for  the  special 
diet  prescribed  are  briefly  described.  Medical  men  will  find  the  dietaries  and 
recipes  practically  useful,  and  likely  to  save  them  trouble  in  directing  the  dietetic 
treatment  of  patients. 


CATALOGUE    OF  MEDICAL    WORKS.  33 


/  MANUAL  OF  PHYSIOLOGY,  with  Practical  Exercises.  For 
Students  and  Practitioners.  By  G.  N.  STEWART,  M.  A.,  M.  D.,  D.  Sc., 
lately  Examiner  in  Physiology,  University  of  Aberdeen,  and  of  the  New 
Museums,  Cambridge  University  ;  Professor  of  Physiology  in  the  Western 
Reserve  University,  Cleveland,  Ohio.  Handsome  octavo  volume  of  848 
pages,  with  300  illustrations  in  the  text,  and  5  colored  plates.  Price,  Cloth, 

53.75  net. 

THIRD  EDITION,  REVISED. 

"  It  will  make  its  way  by  sheer  force  of  merit,  and  amply  deserves  to  do  so.  It  is  one  oj 
the  very  best  English  text-books  on  the  subject." — London  Lancet. 

"  Of  the  many  text-books  of  physiology  published,  we  do  not  know  of  one  that  so  nearly 
comes  up  to  the  ideal  as  does  Professor  Stewart's  volume." — British  Medical  Journal. 

ESSENTIALS  OF  PHYSICAL  DIAGNOSIS  OF  THE  THORAX. 

By  ARTHUR  M.  CURWIN,  A.  M.,  M.  D.,  Demonstrator  of  Physical  Diagno- 
sis in  the  Rush  Medical  College,  Chicago;  Attending  Physician  to  the 
Central  Free  Dispensary,  Department  of  Rhinology,  Laryngology,  and 
Diseases  of  the  Chest.  200  pages.  Illustrated.  Cloth,  flexible  covers. 
Price.  $1.25  net. 

SECOND  EDITION,  THOROUGHLY  REVISED  AND  ENLARGED. 

SYLLABUS  OF  OBSTETRICAL  LECTURES  in  the  Medical 
Department,  University  of  Pennsylvania.  By  RICHARD  C.  NORRIS, 
A,  M..  M.  ]).,  Lecturer  on  Clinical  and  Operative  Obstetrics,  University 
of  Pennsylvania.  Third  edition,  thoroughly  revised  and  enlarged.  Crown 
.8vo.  Price,  Cloth,  interleaved  for  notes,  $2.00  net. 

"  This  work  is  so  far  superior  to  others  on  the  same  subject  that  we  take  pleasure  in  call- 
ing attention  briefly  to  its  excellent  features.  It  covers  the  subject  thoroughly,  and  will 
prove  invaluable  both  to  the  student  and  the  practitioner.  The  author  has  introduced  a 
number  of  valuable  hints  which  would  only  occur  to  one  who  was  himself  an  experienced 
teacher  of  obstetrics.  The  subject-matter  is  clear,  forcible,  and  modern.  We  are  especially 
pleased  with  the  portion  devoted  to  the  practical  duties  of  the  accoucheur,  care  of  the  child, 
etc.  The  paragraphs  on  antiseptics  are  admirable;  there  is  no  doubtful  tone  in  the  direc- 
tions given.  No  details  are  regarded  as  unimportant ;  no  minor  matters  omitted.  We  ven- 
ture to  say  that  even  the  old  practitioner  will  find  useful  hints  in  this  direction  which  he  can- 
not afford  to  despise." — Neiu  York  Medical  Record. 

A  SYLLABUS  OF  LECTURES  ON  THE  PRACTICE  OF  SUR- 
GERY, arranged  in  conformity  with  "  An  American  Text-Book 
of  Surgery."  By  N.  SENN,  M.  D.,  PH.  D.,  Professor  of  Surgery  in  Rust 
Medical  College,  Chicago,  and  in  the  Chicago  Polyclinic.  Price,  $2.00. 

This  work  by  so  eminent  an  author,  himself  one  of  the  contributors  to 
"  An  American  Text  Book  of  Surgery,"  will  prove  of  exceptional  value  to 
the  advanced  student  who  has  adopted  that  work  as  his  text-book.  It  is  not 
only  the  syllabus  of  an  unrivalled  course  of  surgical  practice,  but  it  is  also  an 
epitome  of  or  supplement  to  the  larger  work. 

"  The  author  has  evidently  spared  no  pains  in  making  his  Syllabus  thoroughly  comprehen- 
sive, and  har,  added  new  matter  and  alluded  to  the  most  recent  authors  and  operations.  Full 
references  are  also  given  to  all  requisite  details  of  surgical  anatomy  and  pathology." — British 
Medical  Journal,  London. 


34  W-    B.   SAUNDERS' 


THE  CARE  OF  THE  BABY.  By  J.  P.  CROZER  GRIFFITH,  M.  D., 
Clinical  Professor  of  Diseases  of  Children,  University  of  Pennsylvania; 
Physician  to  the  Children's  Hospital,  Philadelphia,  etc.  404  pages,  with 
67  illustrations  in  the  text,  and  5  plates.  121110.  Price,  $1.50. 

SECOND  EDITION,  REVISED. 

A  reliable  guide  not  only  for  mothers,  but  also  for  medical  students  and 
practitioners  whose  opportunities  for  observing  children  have  been  limited. 

"  The  whole  book  is  characterized  by  rare  good  sense,  and  is  evidently  written  by  a  mas- 
terhand.  It  can  be  read  with  benefit  not  only  by  mothers,  but  by  medical  students  and  by 
any  practitioners  who  have  not  had  large  opportunities  for  observing  children."— American 
Journal  of  Obstetrics. 

THE  NURSE'S  DICTIONARY  of  Medical  Terms  and  Nursing 
Treatment,  containing  Definitions  of  the  Principal  Medical  and  Nursing 
Terms,  Abbreviations,  and  Physiological  Names,  and  Descriptions  of  the 
Instruments,  Drugs,  Diseases,  Accidents,  Treatments,  Operations,  Foods, 
Appliances,  etc.  encountered  in  the  ward  or  the  sick-room.  By  HONNOK 
MORTEN,  author  of  "How  to  Become  a  Nurse,"  "Sketches  of  Ho.-pital 
Life,"  etc.  i6mo,  140  pages.  Price,  Cloth,  $1.00. 

This  little  volume  is  intended  for  use  merely  as  a  small  reference-book  which 
can  be  consulted  at  the  bedside  or  in  the  ward.  It  gives  sufficient  explanation 
to  the  nurse  to  enable  her  to  comprehend  a  case  until  she  has  leisure  to  look  up 
larger  and  fuller  works  on  the  subject. 

DIET  LISTS  AND  SICK-ROOM  DIETARY.  By  JEROME  B.  THOMAS, 
M.  D.,  Visiting  Physician  to  the  Home  for  Friendless  Women  and  Children 
and  to  the  Newsboys'  Home;  Assistant  Visiting  Physician  to  the  Kings 
County  Hospital ;  Assistant  Bacteriologist,  Brooklyn  Health  Department. 
Price,  Cloth,  $1.50  (Send  for  specimen  List.) 

One  hundred  and  sixty  detachable  (perforated)  diet  lists  for  Albuminurin, 
Anaemia  and  Debility,  Constipation,  Diabetes,  Diarrhoea,  Dyspepsia,  Fevers, 
Gout  qr  Uric-Acid  Diathesis,  Obesity,  and  Tuberculosis.  Also  forty  detachable 
sheets  of  Sick-Room  Dietary,  containing  full  instructions  for  preparation  of 
easily-digested  foods  necessary  for  invalids.  Each  list  is  numbered  only,  the 
disease  for  which  it  is  to  be  used  in  no  case  being  mentioned,  an  index  key 
being  reserved  for  the  physician's  private  use. 

DIETS  FOR  INFANTS  AND  CHILDREN  IN  HEALTH  AND 
IN  DISEASE.  By  Louis  STARR,  M.  D.,  Editor  of  "An  American 
Text-Book  of  the  Diseases  of  Children."  230  blanks  (pocket-book  size), 
perforated  and  neatly  bound  in  flexible  morocco.  Price,  $1.25  net. 

The  first  series  of  blanks  are  prepared  for  the  first  seven  months  of  infanl 
life;  each  blank  indicates  the  ingredients,  but  not  the  quantities,  of  the  food. 
the  latter  directions  being  left  for  the  physician.  After  the  seventh  month, 
modifications  being  less  necessary,  the  diet  lists  are  printed  in  full.  Formula 
foi  tne  preparation  of  diluents  and  foods  are  appended. 


CATALOGUE   OF  MEDICAL    WORKS,  35 

HOW  TO  EXAMINE  FOR  LIFE  INSURANCE.  By  JoifN  M. 
KEATING,  M.  D.,  Fellow  of  the  College  of  Physicians  and  Surgeons  of 
Philadelphia ;  Vice-President  of  the  American  Paediatric  Society;  Ex- 
President  of  the  Association  of  Life  Insurance  Medical  Directors.  Royal 
8vo,  211  pages,  with  two  large  half-tone  illustrations,  and  a  plate  prepared 
by  Dr.  McClellan  from  special  dissections ;  also,  numerous  cuts  to  elucidate 
the  text.  Third  edition.  Price,  Cloth,  $2.00  net. 

"  This  is  by  far  the  most  useful  book  which  has  yet  appeared  on  insurance  examination,  a 
subject  of  growing  interest  and  importance.  Not  the  least  valuable  portion  of  the  volume  is 
Part  II.,  which  consists  of  instructions  issued  to  their  examining  physicians  by  twenty-four 
representative  companies  of  this  country.  As  the  proofs  of  these  instructions  were  corrected 
by  the  directors  of  the  companies,  they  form  the  latest  instructions  obtainable.  If  for  these 
alone,  the  book  should  be  at  the  right  hand  of  every  physician  interested  in  this  special  branch 
of  medical  science." — The  Medical  News,  Philadelphia. 

NURSING:    ITS    PRINCIPLES   AND    PRACTICE.      By   ISABEL 

ADAMS  HAMPTON,  Graduate  of  the  New  York  Training  School  for 
Nurses  attached  to  Bellevue  Hospital ;  Superintendent  of  Nurses  and 
Principal  of  the  Training  School  for  Nurses,  Johns  Hopkins  Hospital, 
Baltimore,  Md. ;  late  Superintendent  of  Nurses,  Illinois  Training  School 
for  Nurses,  Chicago,  111.  In  one  very  handsome  I2mo  volume  of  512 
pages,  illustrated.  Price,  Cloth,  $2.00  net. 

SECOND   EDITION,  REVISED  AND  ENLARGED. 

This  original  work  on  the  important  subject  of  nursing  is  at  once  comprehensive 
and  systematic.  It  is  written  in  a  clear,  accurate,  and  readable  style,  suitable 
alike  to  the  student  and  the  lay  reader.  Such  a  work  has  long  been  a  desidera- 
tum with  those  entrusted  with  the  management  of  hospitals  and  the  instruction  of 
nurses  in  training-schools.  It  is  also  of  especial  value  to  the  graduated  nurse 
who  desires  to  acquire  a  practical  working  knowledge  of  the  care  of  the  sick 
and  the  hygiene  of  the  sick-room. 

OBSTETRIC  ACCIDENTS,  EMERGENCIES,  AND  OPERA- 
TIONS. By  L.  CH.  BOISLINIERE,  M.  D.,  late  Emeritus  Professor  of 
Obstetrics  in  the  St.  Louis  Medical  College.  381  pages,  handsomely  illus- 
trated. Price,  $2.00  net. 

"  For  the  use  of  the  practitioner  who,  when  away  from  home,  has  not  the 
opportunity  of  consulting  a  library  or  of  calling  a  friend  in  consultation.  He 
then,  being  thrown  upon  his  own  resources,  will  find  this  book  of  benefit  in 
guiding  and  assisting  him  in  emergencies." 

INFANT'S  WEIGHT  CHART.  Designed  by  J.  P.  CROZER  GRIFFITH, 
M.  D.,  Clinical  Professor  of  Diseases  of  Children  in  the  University  of  Penn 
sylvania.  25  charts  in  each  pad.  Price  per  pad,  50  cents  net. 

A  convenient  blank  for  keeping  a  record  of  the  child's  weight  during  the  first 
two  years  of  life.  Printed  on  each  chart  is  a  curve  representing  the  average  weight 
of  a  healthy  infant,  so  that  any  deviation  from  the  normal  can  readily  be  detected 


SAUNDERS' 
NEW  SERIES 
OF  MANUALS 


for  Students 
and 
Practitioners. 


'T'HAT  there  exists  a  need  for  thoroughly  reliable  hand-books  on  the  leading 
*•  branches  of  Medicine  and  Surgery  is  a  fact  amply  demonstrated  by  the 
favor  with  which  the  SAUNDERS  NEW  SERIES  OF  MANUALS  have  been 
received  by  medical  students  and  practitioners  and  by  the  Medical  Press. 
These  manuals  are  not  merely  condensations  from  present  literature,  but 
are  ably  written  by  well-known  authors  and  practitioners,  most  of  them  being 
teachers  in  representative  American  colleges.  Each  volume  is  concisely  and 
authoritatively  written  and  exhaustive  in  detail,  without  being  encumbered 
with  the  introduction  of  "  cases,"  which  so  largely  expand  the  ordinary  text- 
book. These  manuals  will  therefore  form  an  admirable  collection  of  advanced 
lectures,  useful  alike  to  the  medical  student  and  the  practitioner:  to  the  latter, 
loo  busy  to  search  through  page  after  page  of  elaborate  treatises  for  what  he 
wants  to  know,  they  will  prove  of  inestimable  value  ;  to  the  former  they  will 
afford  safe  guides  to  the  essential  points  of  study. 

The  SAUNDERS  NEW  SERIES  OK  MANUALS  are  conceded  to  be 
superior  to  any  similar  books  now  on  the  market.  No  other  manuals  afford  so 
much  information  in  such  a  concise  and  available  form.  A  liberal  expenditure 
has  enabled  the  publisher  to  render  the  mechanical  portion  of  the  work  worthy 
of  the  high  literary  standard  attained  by  these  books. 

Any  of  these  Manuals  will  be  mailed  on  receipt  of  price  (see  next  page 
'or  Li«t). 


SAUNDERS'  NEW  SERIES  OF  MANUALS, 


VOLUMES  PUBLISHED. 


PHYSIOLOGY.  By  JOSEPH  HOWARD  RAYMOND,  A.  M.,  M.  D.,  Professor 
of  Physiology  and  Hygiene  and  Lecturer  on  Gynecology  in  the  Long 
Island  College  Hospital,  etc.  Price,  $1.25  net. 

SURGERY,  General   and  Operative.     By   JOHN   CHALMERS  DACOSTA, 

M.  D.,  Professor  of  Clinical  Surgery,  Jefferson  Medical  College,  Philadel- 
phia. Second  edition,  revised  and  greatly  enlarged.  Octavo,  911  pages, 
386  illustrations.  Cloth,  $4.00  net ;  Half- Morocco,  $5.00  net. 

DOSE-BOOK  AND  MANUAL  OF  PRESCRIPTION- WRITING. 

By  E.  Q.  THORNTON,  M.  D.,  Demonstrator  of  Therapeutics,  Jefferson 
Medical  College,  Philadelphia.  Price,  $1.25  net. 

MEDICAL  JURISPRUDENCE.  By  HENRY  C.  CHAPMAN,  M.  D.,  Pro- 
fessor of  Institutes  of  Medicine  and  Medical  Jurisprudence  in  the  Jeffer- 
son Medical  College  of  Philadelphia,  etc,  Price,  $1.50  net. 

SURGICAL  ASEPSIS.  By  CARL  BECK,  M.D.,  Surgeon  to  St.  Mark's 
Hospital  and  to  the  German  Poliklinik ;  Instructor  in  Surgery,  New  York 
Post-Graduate  Medical  School,  etc.  Price,  $1.25  net. 

MANUAL  OF  ANATOMY.  By  IRVING  S.  HAYNES,  M.  D.,  Adjunct 
Professor  of  Anatomy  and  Demonstrator  of  Anatomy,  Medical  Department 
of  the  New  York  University,  etc.  Price,  $2.50  net. 

SYPHILIS  AND  THE  VENEREAL  DISEASES.  By  JAMES 
NEVINS  HYDE,  M.D.,  Professor  of  Skin  and  Venereal  Diseases,  and 
FRANK  H.  MONTGOMERY,  M.  D.,  Lecturer  on  Dermatology  and  Genito- 
urinary Diseases  in  Rush  Medical  College,  Chicago.  Price,  $2.50  net. 

PRACTICE  OF  MEDICINE.  By  GEORGE  ROE  LOCKWOOD,  M.  D., 
Professor  of  Practice  in  the  Woman's  Medical  College  of  the  New  York 
Infirmary,  etc.  Price,  $2.50  net. 

OBSTETRICS.  By  W.  A.  NEWMAN  DORI.AND,  M.  D.,  Assistant  Demon- 
strator of  Obstetrics,  University  of  Pennsylvania;  Chief  of  Gynecological 
Dispensary,  Pennsylvania  Hospital.  Price,  $2.50  net. 

DISEASES  OF  WOMEN.  By  J.  BLAND  SUTTON,  F.  R.  C.  S.,  Assistant 
Surgeon  to  the  Middlesex  Hospital,  and  Surgeon  to  the  Chelsea  Hospital 
for"  Women,  London ;  and  ARTHUR  E.  GILES,  M.  D.,  B.  Sc.  Lond.,  F.  R.  C.  S. 
Edin.,  Assistant  Surgeon  to  the  Chelsea  Hospital  for  Women,  London.  436 
pages,  handsomely  illustrated.  Price,  $2.50  net. 

IN    PREPARATION. 

NERVOUS  DISEASES.  By  CHARLES  W.  BURR,  M.  D.,  Clinical  Profes- 
sor of  Nervous  Diseases,  Medico-Chirurgical  College,  Philadelphia,  etc. 

***  There  will  be  published  in  the  same  series,  at  short  intervals,  carefully  prepared  works 
on  various  subjects,  by  prominent  specialists. 


SAUNDERS'  QUESTION  COMPENDS. 

Arranged  in  Question  and  Answer  Form, 

THE  LATEST,  MOST  COMPLETE,  and  BEST  ILLUSTRATED 
SERIES  OF  COMPENDS  EVER  ISSUED. 

Now  the  Standard  Authorities  in  Medical  Literature 


Students  and  Practitioners  in  every  City  of  the  United 
States  and  Canada. 


THE    REASON    WHY. 

They  are  the  advance  guard  of  "  Student's  Helps  " — that  DO  HELP  ;  they  are 
the  leaders  in  their  special  line,  well  and  authoritatively  written  by  able  men, 
who,  as  teachers  in  the  large  colleges,  know  exactly  what  is  wanted  by  a  student 
preparing  for  his  examinations.  The  judgment  exercised  in  the  selection  of 
authors  is  fully  demonstrated  by  their  professional  elevation.  Chosen  from  the 
ranks  of  Demonstrators,  Quiz-masters,  and  Assistants,  most  of  them  have  be- 
come Professors  and  Lecturers  in  their  respective  colleges. 

Each  book  is  of  convenient  size  (5x7  inches),  containing  on  an  average  250 
pages,  profusely  illustrated,  and  elegantly  printed  in  clear,  readable  type,  on 
fine  paper. 

The  entire  series,  numbering  twenty- four  subjects,  has  been  kept  thoroughly 
revised  and  enlarged  when  necessary,  many  of  them  being  in  their  fourth  and 
fifth  editions. 

TO   SUM    UP. 

Although  there  are  numerous  other  Quizzes,  Manuals,  Aids,  etc.  in  the  mar- 
ket, none  of  them  approach  the  "Blue  Series  of  Question  Compends;"  and 
the  claim  is  made  for  the  following  points  of  excellence : 

1.  Professional  distinction  and  reputation  of  authors. 

2.  Conciseness,  clearness,  and  soundness  of  treatment. 

3.  Size  of  type  and  quality  of  paper  and  binding. 

••'  ;*  Any  of  these  Compends  will  be  mailed  on  receipt  of  price  (see  next 
page  for  List). 

38 


SAUNDERS'  QUESTION-COMPEND  SERIES. 


Price,  doth,  $1.00  per  copy,  except  when  otherwise  noted. 

1.  ESSENTIALS  OF  PHYSIOLOGY.    4th  edition.    Illustrated.    Revised  and  enlarged. 

By  H    A.  HARE,  M.  D.     (Price,  Ji.oo  net.) 

2.  ESSENTIALS  OF  SURGERY.     6th  edition,  with  an  Appendix  on  Antiseptic  Sur- 

gery.    90  illustrations.     By  EDWARD  MARTIN,  M.  D. 

3.  ESSENTIALS  OF  ANATOMY.     6th  edition,  thoroughly  revised.     151  illustrations. 

By  CHARLES  B.  NANCREDE.  M.  D. 

4.  ESSENTIALS  OF  MEDICAL  CHEMISTRY,  ORGANIC  AND  INORGANIC. 

5th  edition, revised,  with  an  Appendix.     By  LAWRENCE  WOLFF,  M.  D. 

5.  ESSENTIALS  OF  OBSTETRICS.     4'h  edition,  revised  and  enlarged.     75  illustra- 

tions.    By  W.  EASTERLY  ASHTON,  M.  D. 

6.  ESSENTIALS  OF  PATHOLOGY  AND  MORBID  ANATOMY,     yth  thousand. 

46  illustrations.     By  C.  E.  ARMAND  SEMPLE,  M.  D. 

7.  ESSENTIALS    OF    MATERIA     MEDICA,    THERAPEUTICS,    AND    PRE- 

SCRIPTION-WRITING.     5th  edition.      By  HENRY  MORRIS,  M.  D. 

8,9.  ESSENTIALS  OF  PRACTICE  OF  MEDICINE.  By  HENRY  MORRIS,  M.  D. 
An  Appendix  on  UKI.NK  KXAMIN  ATION.  Illustrated.  By  LAWRENCE  WOLFF,  M.  D. 
3d  edition,  enlarged  by  some  300  Essential  Formulae,  selected  from  eminent  authori- 
ties, by  WM.  M.  POWELL,  M.  D.  (Double  number,  price  $2.00.) 

10.  ESSENTIALS  OF  GYNAECOLOGY.     4th  edition,  revised.     With  62  illustrations. 

By  EDWIN  B.  CRAGIN,  M.  D. 

11.  ESSENTIALS  OF  DISEASES  OF    THE  SKIN.  4th  edition,  revised  and  enlarged. 

71  letter-press  cuts  and  15  half-tone  illustrations.    By  HENRY  W.  STELWAGON,  M.D. 
(Price,  $1.00  net.) 

12.  ESSENTIALS  OF  MINOR    SURGERY,  BANDAGING,  AND  VENEREAL 

DISEASES.     2d   edition,   revised    and    enlarged.     78  illustrations.      By  EDWARD 
MARTIN,  M.  D. 

13.  ESSENTIALS  OF  LEGAL    MEDICINE,  TOXICOLOGY,  AND   HYGIENE. 

130  illustrations.     By  C.  E.   ARMAND  SEMPLE,  M.  D. 

14.  ESSENTIALS  OF  DISEASES  OF   THE  EYE,  NOSE,  AND  THROAT.    124 

illustrations.     2rl  edition,  revised.     By  EDWARD  JACKSON,  M.D7,~and  E.  BALDWIN 
(  VLKASON,  M.  D. 

15.  ESSENTIALS  OF    DISEASES  OF  CHILDREN.     2d  edition.     By  WILLIAM  M. 

POWELL,  M.D. 

16  ESSENTIALS  OF  EXAMINATION  OF  URINE.  Colored  "VooEL  SCALE," 
and  numerous  illustrations.  By  LAWRENCE  WOLFF,  M.D.  (Price,  75  cents.) 

17.  ESSENTIALS  OF   DIAGNOSIS.     55   illustrations,  some  in  colors.     By  S.  SOLIS- 

COHEN,  M    D  ,  and  A.  A.  ESHNER,  M.  D.     (Price,  $1.50  net.) 

18.  ESSENTIALS  OF   PRACTICE  OF  PHARMACY.     2d   edition,  revised.     By  L. 

E.  SAYRE. 

20.  ESSENTIALS  OF   BACTERIOLOGY.      3d   edition.     82   illustrations.     By  M.  V. 

BALL,  M.  D. 

21.  ESSENTIALS  OF  NERVOUS  DISEASES  AND  INSANITY.   48  illustrations. 

3d  edition,  revised.     By  JOHN  C.  SHAW,  M.  D. 

22.  ESSENTIALS  OF  MEDICAL  PHYSICS.     155  illustrations.     2d  edition,  revised. 

By  FRED  J.  BROCKWAY,  M.  D.     (Price,  $1.00  net.) 

23.  ESSENTIALS  OF  MEDICAL  ELECTRICITY.    65  illustrations.     By  DAVID  D. 
•  STEWART,  M.  D.,  and  EDWARD  S.  LAWRANCE,  M.  D. 

24.  ESSENTIALS  OF  DISEASES  OF  THE  EAR.     114  illustrations,    zd  edition,  re- 

vised and  enlarged.     By  E.  BALDWIN  GLEASON,  M.  D. 

39 


IN  PRESS 

FOR  PUBLICATION  EARLY  IN  THE  FALL  OF   1899. 

THE  INTERNATIONAL  TEXT-BOOK  OF  SURGERY.    In  two  v.  I 

l!y  American  and  Urin.sh  authors.  Kdited  l>y  |.  <',  ,|  i  INS  WAKKKN,  M.  D. 
I  I  .  1 1.,  Professor  of  Surgery,  llarvuid  Medical  School,  P,o>ton  ;  Surgeon 
to  the  Massachusetts  General  Hospital;  and  A.  PI:AK<  i  Gom.n,  M.  S., 
K.  K.  ('.  S.,  KIII;.,  Lecturer  on  I'ractical  Surgery  ami  Tt  arhn  of  Operative 
Surgery,  Middlesex  Hospital  Medical  School;  Surgeon  (<>  the  Middlesex 
Hospital,  London,  England.  Vol.  I.  Handsome  octavo  volume  of  about 
95°  Pag6**  w'ln  over  4°°  Beautiful  illustrations  in  the  text,  and  9  litho- 
graphic plates. 

HEISLER'S   EMBRYOLOGY. 

A  Text-Book  of  Embryology.  By  JOHN  C.  HKISI.KR,  M.D..  Pro- 
fessor of  Anatomy  in  the  Medico-Chirurgical  College,  Philadelphia.  I2mo 
volume  of  about  325  pages,  handsomely  illustrated. 

KYLE  ON  THE  NOSE  AND  THROAT. 

Diseases  of  the  Nose  and  Throat.  By  I).  BRADF.N  KYI.E,  M.  D., 
Clinical  Professor  of  Laryngology  and  Rhinology,  Jefferson  Medical  Col- 
lege, Philadelphia;  Consulting  Laryngologist,  Rhinologist,  and  Olol»iM>t, 
St.  Agnes'  Hospital.  Octavo  volume  of  about  630  pages,  with  over  150 
illustrations  and  6  lithographic  plates. 

PRYOR     PELVIC   INFLAMMATIONS. 

The  Treatment  of  Pelvic  Inflammations  through  the  Vagina. 

By  W.  R.  PRYOK,  M.  I).,  Professor  of  Gynecology  in  tin-  New  Vmk  Poly- 
clinic.  I2mo  volume  of  about  250  page-,  handsomely  illustrated. 

ABBOTT  ON   TRANSMISSIBLE    DISEASES. 

The  Hygiene  of  Transmissible  Diseases :  their  Causation, 
Modes  of  Dissemination,  and  Methods  of  Prevention.  i;\  \ 

1  .  AI:I:OM,  M.  D.,  Professor  of  Hygiene  in  the  I'nivcrsity  "I  Penn>yl 
vania  ;  Director  of  the  Laboratory  of  Hygiene.  Octavo  volume  of  about 
325  pages,  containing  a  number  of  charts  and  maps,  and  numerous  illus- 
trations. 

JACKSON     DISEASES   OF   THE   EYE. 

A  Manual  of  Diseases  of  the  Eye.  I>y  KDUARH  JACKSON,  A.M., 
M  D..  laic  Prufessor  of  Diseases  of  the  Eye  in  the  Philadelphia  Polyclinic 
and  College  for  Graduates  in  Medicine.  I2mo  volume  of  over  500  pages, 
with  alwut  175  beautiful  illustrations  from  drawings  by  the  author. 


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